Division of Federal Employees' Compensation (DFEC)
FECA Bulletins have been divided into five-year groups to make it easier for you to search and find the information you are looking for.
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Bulletin |
Subject |
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Medical Exams/IME: Security of Case Records During the Referral Process |
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BPS - Central Bill Processing System - Interim Responses to Requests for Medical Authorization |
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Fiscal - Change of Lockbox Depository Effective December 15, 2004 |
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Compensation Pay: Compensation Rate Changes Effective January 2005 |
Back to FECA Bulletins (2001-2005) Table of Contents
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Bulletin |
Subject |
|---|---|
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Case File Management/Jurisdiction-Special Act Cases |
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ADP - Automated Compensation Payment System (ACPS) Schedule for 2004 |
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Employee – Authorized Providers of Military Honors Funeral Support |
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BPS - Revision in the reimbursement Rates Payable for the Use of Privately Owned Autombiles Necessary to Secure Medical Examination and Treatment |
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Adjudication of Claims - Federal Emergency Management Agency (FEMA) BCT-FY04.nfo Disaster Assistance Employees (DAE) |
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BPS-OWCP-915 - Medical Reimbursement Form and Instructions |
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Compensation Pay: Compensation Rate Changes Effective January 2004 |
Back to FECA Bulletins (2001-2005) Table of Contents
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Bulletin |
Subject |
|---|---|
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Compensation Orders/Letter Decisions - Signature Authority for Journey Level GS-12 and Senior Claims Examiners |
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BPS - Revision in the Reimbursement Rates Payable for the Use of Privately Owned Automobiles Necessary to Secure Medical Examination and Treatment |
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ADP - Automated Compensation Payment System (ACPS) Schedule for 2003 |
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Compensation Pay: Compensation Rate Changes Effective January 2003 |
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Comp Pay/ACPS - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 2003 |
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ADP - Code It Fast I-9 Coding Tool |
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Development and Adjudication of Claims for War-Risk Hazard Cases |
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Medical Exams/IME: Board Certified Osteopathic Physicians in the PDS (Physicians Directory System) |
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BPS - OWCP-957 – Medical Travel Refund Request Form and Instructions for Submitting OWCP-957 |
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Fiscal - Change of Lockbox Depository Effective March 19, 2003 |
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Forms – Foreign Payment Worksheet |
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BPS - Operational Guidelines for the Central Bill Processing system |
Back to FECA Bulletins (2001-2005) Table of Contents
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Bulletin |
Subject |
|---|---|
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FECA Bulletin No. 02-01 |
FECA Bulletin 02-01 (not published) |
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Comp Pay/ACPS - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 2001 |
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Case Management - Authorization of Physical Therapy |
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Revised procedures for processing work-related injury claims filed by employees of the Office of Workers' Compensation Programs and their relatives in the Midwest (formerly Chicago) Region |
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Comp Pay/ACPS – Employing Agency Action to Notify DFEC of Claimant Ineligibility for Continuing Life Insurance |
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Compensation Pay - Compensation Rate Changes Effective January 2002 |
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Comp Pay/ACPS - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 2002 |
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BPS -Revision in the Reimbursement Rates Payable for TheUse of Privately Owned Automobiles(POV) Necessary to Secure Medical Examination and Treatment |
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FECA Bulletin No. 02-09 |
FECA Bulletin 02-09 (not published) |
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Bill Payment-Physical Therapy Multiple Initial Evaluations |
Back to FECA Bulletins (2001-2005) Table of Contents
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Bulletin |
Subject |
|---|---|
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Bill Payment/BPS - "Real-Time" Pharmacy (12/00A) |
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Bill Payment/BPS - Modifications to Inpatient Hospital Bill Procedures (12/00A) |
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Bill Payment/BPS - Prior Authorization for Pharmacy (01/01A) |
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Periodic Roll Management: Evidence of Earnings (01/01A) |
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Impairment/Schedule Awards: Fifth Edition of the AMA Guides to the Evaluation of Permanent Impairment (02/01A) |
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Compensation Pay: Compensation Rate Changes Effective January 2001 (02/01A) |
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BPS - Revision in the Reimbursement Rates Payable for the Use of Privately Owned Automobiles Necessary to Secure Medical Examination and Treatment. (02/01A) |
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Comp Pay - Extra Pay for Firefighters |
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COP Nurse Intervention (02/01B) |
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Bill Pay/BPS - Sampling of Bills |
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Medical- - Use of Physicians Directory System (PDS) |
Back to FECA Bulletins (2001-2005) Table of Contents
FECA BULLETIN NO. 05-01
Issue Date: December 3, 2004
Expiration Date: December 3, 2005
Subject: Medical Exams/IME: Security of Case Records During the Referral Process
Background: The OWCP policy of sending the original case record to the office of the medical specialist performing an impartial medical examination (IME) to resolve a conflict has occasionally resulted in the loss of the claimant's case record. In situations where the case record is fully imaged, the district office merely prints a copy of the case from OASIS. Currently, however, many of the cases requiring an impartial medical examination are in hybrid form, i.e., partially paper and partially imaged. In these cases, the original part of the case record, which is the paper portion, continues to present the problem of possible loss during the transport to and from the physician's office. In light of the foregoing, OWCP has determined that continuing to send the original paper portion of the case record out of the district office represents an unacceptable risk to the security of case records for which the Office is the legal custodian.
References: FECA Procedure Manual Chapter 3-0500.5 and Chapter 2-0810.13.
Purpose: To implement new procedures with respect to the imaging and printing case records prior to referral of the case for an impartial medical examination (IME).
Applicability: Claims Examiners, Senior Claims Examiners, All Claims Supervisors, Medical Schedulers, District Medical Directors, Technical Assistants, System Managers, Staff Nurses, and Vocational Rehabilitation Specialists
Action:
1. Effective immediately the Office will no longer send the original of the paper portion of a hybrid case out of the office for an impartial medical evaluation.
2. The district office can choose to either scan the paper portion of the case into OASIS locally or to provide the impartial medical examiner with a photocopy. The original paper portion of the case file is the official record. Therefore, the original documents must be retained by the district office and handled in accordance with current record retention regulations.
3. If the paper portion of the case is scanned into OASIS locally, the original paper documents should be imaged with a received-date equivalent to the date that the district office "went live" on OASIS. Document indexing of this portion of the imaged record will not be required.
3. Once the hybrid cases are fully imaged, the district offices will send only printed copies of imaged cases for the purpose of review by an IME, or future uses.
The above described procedures will be effective upon the release of this bulletin. Please ensure that proper notification/training is provided to district office personnel that are affected.
Disposition: Retain until incorporated into the FECA Procedure Manual.
JAMES L. DEMARCE
Acting Director for
Federal Employees' Compensation
Distribution: List No. 1, Folioviews Groups A and D (Claims Examiners, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)
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FECA BULLETIN NO. 05-02
Issue Date: February 1, 2005
Expiration Date: February 1, 2006
Subject: BPS - Central Bill Processing System - Interim Responses to Requests for Medical Authorization
Background: Currently, medical providers requesting prior authorization for medical services do not receive a response from ACS or the responsible claims examiner (RCE) when additional development must be undertaken. The current process leaves the requesting medical provider without any information concerning the status of the authorization request. In addition, ACS is unable to provide any information concerning the authorization request to callers.
In order to facilitate communication on these issues, OWCP will advise ACS that further medical development is being undertaken. Effective February 7, 2005, ACS will begin to enter a code into the authorization system which will denote that further medical development is in process. Also, an interim response will be given to the provider who has requested authorization for medical procedures.
Reference: "How to Resolve Threads" (see OWCP Central Bill Intranet Site), PM 2-0810, PM 3-0500, PM 2-600-3.
Purpose: To provide procedures for issuing interim response letters to providers requesting authorization for medical procedures.
Applicability: Claims Examiners, Senior Claims Examiners, All Claims Supervisors, Medical Schedulers, District Medical Advisors, Technical Assistants, System Managers, Staff Nurses, Vocational Rehabilitation Specialists, Communications Specialists, Fiscal Operations Specialists, Medical Coding Specialists, and Customer Service Representatives.
Action:
1. Interim responses will be issued to medical providers by ACS when the RCE is not able to approve a requested procedure. The thread will be returned to ACS by the RCE within three workdays of receipt. ACS will update the thread status to reflect "further development" (F). ACS will also update its authorization request files with this information.
2. ACS will generate a letter to the provider stating that the requested medical service cannot be approved at this time and that additional medical development is being undertaken by OWCP. The RCE will have 7 days from the day the thread is sent back to ACS to initiate the development.
3. Each additional step in the development process should be initiated within 14 calendar days of completion of the previous step. For example, if the DMA returns his/her opinion and it is determined that a SECOP is needed, the RCE should initiate the SECOP process within 14 calendar days of the DMA's opinion. Regular SECOP and IME procedures for notifying the claimant remain in effect and are not changed with this Bulletin.
4. If the RCE determines that a formal decision denying the authorization request is appropriate, he or she will issue the decision to the injured worker. The RCE will send a thread to ACS advising that the authorization has been denied. A copy of the formal decision will not be sent to the provider.
5. All threads can be viewed in Omni-Track by office, unit, or CE based on user level. The instructions for locating threads can be found on the help site under the category "Threads," followed by the sub-category "How to Find Threads."
Disposition: Retain until incorporated into the FECA Procedure Manual.
JAMES L. DEMARCE
Acting Director for
Federal Employees' Compensation
Distribution: List No. 3 Folioviews Groups A, B, C, and D (All FECA Employees)
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FECA BULLETIN NO. 05-03
Issue Date: February 14, 2005
Expiration Date: February 14, 2006
Subject: Fiscal - Change of Lockbox Depository Effective December 15, 2004.
Background: In March 2003, the U.S. Treasury/Financial Management Service (FMS) received bids from various financial institutions on the contract to provide lockbox services to all federal agencies. These initial bids were limited to Regions 4 and 5, and were finalized in October 2004, when the contract for services was awarded to Citibank. As a result, certain DFEC lockbox accounts will no longer reside with Bank of America and instead will be serviced by Citibank.
Purpose: To inform the appropriate personnel of the change in lockbox depository addresses, ensuring the proper processing of all incoming cash receipts.
Applicability: Appropriate National and District Office personnel. This includes each district office that previously had a lockbox account with Bank of America of San Francisco, California (Denver - D.O. 12; San Francisco - D.O. 13; and Seattle - D.O. 14) or Bank of America of Dallas, Texas (Kansas City - D.O. 11 and Dallas - D.O. 16). All DFEC lockboxes with an account through Bank of America of Atlanta, Georgia are not affected and their depository accounts will remain the same. Contracts for the remaining regions will be bid upon in 2005. The current list of all DFEC lockboxes is attached to this publication.
Action:
1. All letters requesting that payment be mailed directly to the lockbox depository should be changed immediately. All letters pertaining to overpayment decisions (CA-2223, CA-2225, and the CA-9000 series) should be changed at each district office to reflect the new lockbox address as detailed in the attached listing.
2. The DFEC System Managers have already been notified f the needed address change via e-mail, and should have modified the district office's "v44_lb_addr table". This update will also automatically update the Letter Generator System (LGS), since the LGS retrieves the lockbox addresses from this part of the v44 table through "letters.cgi" when the "Generate Letter" button is clicked.
3. All other appropriate district office personnel, including designated third party examiners, must be made aware of the local lockbox address change.
4. Deposits sent to old lockbox addresses will only be forwarded to Citibank for approximately six months. The affected district offices must therefore make every effort to notify and update any individuals or organizations that are currently sending cash deposits to their lockboxes.
5. All deposits mailed from the district office to the lockbox after December 15, 2004, should be mailed to the new lockbox address.
6. It will also be necessary for each district office to identify all Office of Personnel Management (OPM) and salary off-sets that are currently being mailed directly to their lockbox. The Cash Receipts Register will serve as a source for quick identification of such deposits. Notices must be sent to OPM and/or the employing agency immediately.
7. Deposit transactions will be made in the same manner as those with Bank of America. Transaction data will be sent from Citibank to the district offices via FedEx. "Zero Activity" reports from Citibank will not be forwarded, only daily reporting with actual deposit activity. In addition, daily "zero activity" notices will be sent via first-class mail, rather than FedEx. The date of deposit will continue to be the Treasury confirmation date.
The DFEC contact person at Citibank for all questions or concerns is Bonnie Coffield. Ms. Coffield can be reached by telephone at (302) 324-6484, and by e-mail at bonnie.l.coffield@citigroup.com.
The Treasury/FMS contact for the lockboxes is John Schmid, who may be reached at (202) 874-7026, and by e-mail at John.Schmid@fms.treas.gov.
Disposition: This bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until the indicated expiration date.
JAMES L. DEMARCE
Acting Director for
Federal Employees' Compensation
Distribution: List No. 2--Folioviews Groups A and D (Claims Examiners, All Supervisors, Systems Managers, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal and Bill Pay Personnel)
Attachment to FB 05-03
LOCKBOX DEPOSITY ADDRESSES – DECEMBER 2004
The following is a listing of the current mailing address for all DFEC lockboxes. This listing has been revised to include the new addresses for all lockboxes that have been switched from Bank of America to Citibank. All other district office lockbox addresses remain changed.
Boston District Office:
U.S. Dept. of Labor – DFEC Boston
P.O. Box 403498
Atlanta, GA 30384-3498
New York District Office:
U.S. Dept. of Labor – DFEC New York
P.O. Box 403484
Atlanta, GA 30384-3484
Philadelphia District Office:
U.S. Dept. of Labor – DFEC Philadelphia
P.O. Box 403471
Atlanta, GA 30384-3471
Jacksonville District Office:
U.S. Dept. of Labor – DFEC Jacksonville
P.O. Box 403376
Atlanta, GA 30384-3376
Cleveland District Office:
U.S. Dept. of Labor – DFEC Cleveland
P.O. Box 403459
Atlanta, GA 30384-3459
Chicago District Office:
U.S. Dept. of Labor – DFEC Chicago
P.O. Box 403449
Atlanta, GA 30384-3449
Kansas City District Office:
U.S. Dept. of Labor
Kansas City FECA Office
P.O. Box 894227
Los Angeles, CA 90189-4227
Denver District Office:
U.S. Dept. of Labor
Denver FECA Office
P.O. Box 894204
Los Angeles, CA 90189-4204
San Francisco District Office:
U.S. Dept. of Labor
San Francisco FECA Office
P.O. Box 894221
Los Angeles, CA 90189-4221
Seattle District Office:
U.S. Dept. of Labor
Seattle FECA Office
P.O. Box 894212
Los Angeles, CA 90189-4212
Dallas District Office:
U.S. Dept. of Labor
Dallas FECA Office
P.O. Box 894225
Los Angeles, CA 90189-4225
Washington D.C. District Office:
U.S. Dept. of Labor – DFEC Washington D.C.
P.O. Box 403431
Atlanta, GA 30384-3431
National Office:
U.S. Dept. of Labor – DFEC National Office
P.O. Box 403356
Atlanta, GA 30384-3356
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FECA BULLETIN NO. 05-04
Issue Date: April 10, 2005
Expiration Date: April 10, 2006
Subject: Compensation Pay: Compensation Rate Changes Effective January 2005.
Background: On December 30, 2004, the President signed an Executive Order implementing a salary increase of 2.50 percent in the basic pay for the General Schedule. The applicability under 5 U.S.C. 8112 only includes the 2.50 percent increase in the basic General Schedule. Any percent increase for locality-based pay is excluded.
Purpose: To inform the appropriate personnel of the increased minimum/maximum compensation rates and the adjustment procedures for affected cases on the periodic disability and death payrolls.
The new rates were effective with the first compensation payroll period beginning on or after January 1, 2005, making January 9, 2005 the effective date of the increase. The new maximum compensation rate payable is based on the scheduled salary of a GS-15, Step 10, which is now $116,517 per annum. The basis for the minimum compensation rate is the salary of $18,007 per annum (GS-2, Step 1). The minimum increase specified in this Bulletin is applicable to Postal employees.
The effect on 5 U.S.C. 8112 is to increase the payment of compensation for disability claims to:
|
Effective January 9, 2005 |
Minimum |
Maximum |
|---|---|---|
|
28-Day Cycle |
$1,038.88 |
$6,722.12 |
The effect on 5 U.S.C. 8133(e) is to increase the monthly pay on which compensation for death is computed to:
|
Effective January 12, 2004 |
Minimum |
Maximum |
|---|---|---|
|
Monthly |
$1,501.00 |
$7,282.00 |
Applicability: Appropriate National and District Office personnel
Reference: Memorandum for Executive Heads of Departments and Agencies dated December 30, 2004, and the attachment for the 2005 General Schedule
Action: ACPS will update the periodic disability and death payrolls. Any cases with gross overrides will not have a supplemental record created. Thus, the cases with gross overrides must be reviewed to determine if adjustments are necessary. If adjustment is necessary, a manual calculation will be required.
1. Adjustments Dates.
a. As the effective date of the adjustment was January 9, 2005, there was no supplemental payroll needed for the periodic disability and death rolls.
b. The new minimum/maximum compensation rates were available in ACPS on January 20, 2005.
2. Adjustment of Daily Roll Payments. The salary adjustments are not retroactive, so it is assumed that all Federal agencies have ample time to receive and report the new pay rates on claims for compensation filed on or after January 1, 2005. Therefore, it is not necessary to review any of these payments. However, if an inquiry is received, verification of the pay rate must be secured from the employing establishment and the necessary adjustment applied.
3. Minimum and Maximum Adjustment Listings. Form CA-842, Minimum Compensation Pay Rates, and Form CA-843, Maximum Compensation Rates, should be annotated with the new rate information as follows:
|
CA-842 – 01/03/05 |
||||||
|
51.94-77.91 |
259.72-389.55 |
51.94 |
259.72(1,038.88) |
1,501.00 |
51.94-69.28 |
259.72-346.38 |
|
CA-843 – 01/03/05 |
||||||
|
336.11 |
1,680.53(6,722.12) |
7,282.00 |
||||
4. Forms. CP-150, Minimum/Maximum Compensation, was generated for each case adjusted. It should be noted that this adjustment process re-calculates EVERY ACPS record from very beginning to current date, thus, it may be that minor changes in the gross compensation are noted; this is not necessarily incorrect. Notices to all payees receiving periodic compensation payments were generated, informing them of potential changes to their compensation benefits.
The notices were sent as an attachment to the Benefit Statement generated after each periodic cycle. Manual adjustments necessary because of gross overrides should be made on Forms CA-24 or CA-25 with a notice sent to the payee by the District Office.
Disposition: This bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until the indicated expiration date.
DOUGLAS FITZGERALD
Director for
Federal Employees' Compensation
Distribution: List No 2:- -Folioviews Groups A and D (Claims Examiners, All Supervisors, Systems Managers, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal and Bill Pay Personnel)
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FECA BULLETIN NO. 04-01
Issue Date: November 28, 2003
Expiration Date: November 28, 2004
Subject: Case File Management/Jurisdiction-Special Act Cases
Background: Current procedures require that all claims for benefits under the War Claims Act (WC), War Hazards Compensation Act (WH), and those filed by members of the Reserve Officer Training Corps (ROTC) be adjudicated and managed in the National Operations Office (NOO). In addition, current procedures require that all claims filed by returned Peace Corps volunteers be processed and serviced in the NOO until they have been adjudicated, after which they may be transferred to the district office that has general jurisdiction.
Reference: Federal (FECA) Procedure Manual, Chapter 1-200-2 and Chapter 1-200-3.
Purpose: To transfer jurisdiction for all claims filed under the War Claims Act and War Hazards Compensation Act or filed by ROTC cadets (TC) or returned Peace Corps volunteers from the NO (District 25) to the Cleveland District Office (District 9)
Applicability: Regional Directors, District Directors, Claims Examiners, All Supervisors, Systems Managers, Technical Assistants, Rehabilitations Specialists, and Staff Nurses.
Action:
1. Effective immediately, all claims filed by returned Peace Corps volunteers and ROTC cadets, as well as those filed under the War Claims Act and the War Hazards Compensation Act, fall under the jurisdiction of, and should be filed in District 9. All TC, WC and WH claims will be adjudicated and maintained in District 9. New claims for returned Peace Corps volunteers will be adjudicated in District 9. Accepted Peace Corps cases will be transferred to the district office having general jurisdiction.
2. The NOO will forward all existing case files involving War Claims, War Hazards, and ROTC cadets to District 9. Previously accepted Peace Corps cases will be transferred to the district office having general jurisdiction.
3. All mail should continue to be sent to our central mailroom in London, Kentucky. All questions concerning medical bill payment or pre-authorization for medical services should continue to be routed to our central bill processor through either the internet at the OWCP web bill portal, or by telephone at (866) 335-8319.
4. The Cleveland district office address is:
U.S. Department of Labor
Office of Workers' Compensation Programs
1240 East 9th Street, Room 851
Cleveland, Ohio 44199
Disposition: This Bulletin should be retained until incorporated into the Federal (FECA) Procedure Manual, or otherwise superseded.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 1--Folioviews Groups A,B,C,D (Regional Directors, District Directors, Claims Examiners, All Supervisors, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)
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FECA BULLETIN NO. 04-02
Issue Date: December 5, 2003
Expiration Date: December 5, 2004
Subject: ADP - Automated Compensation Payment System (ACPS) Schedule for 2004.
Purpose: To provide the 2004 schedule for processing the periodic disability and death payrolls under the ACPS for calendar year 2004.
Applicability: Appropriate National Office and District Office personnel that need to be aware of both the periods and "cut-off" dates for the ACPS periodic disability, death, and weekly payrolls.
Disposition: This Bulletin should be retained in front of Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until the indicated expiration date.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 2 -- Folioviews Groups A and D Claims Examiners, All Supervisors, Systems Managers, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal/Bill Pay Personnel)
Attachment
|
CHECK |
PERIOD OF |
BI-WEEKLY PAY PERIODS |
DISTRICT |
N.O. |
|---|---|---|---|---|
|
1 |
12/28/03– 01/24/04 |
12/28/03 – 01/10/04 |
01/14/04 |
01/16/04 |
|
2 |
01/25/04 – 02/21/04 |
01/25/04 – 02/07/04 |
02/11/04 |
02/13/04 |
|
3 |
02/22/04 – 03/20/04 |
02/22/04 – 03/06/04 |
03/10/04 |
03/12/04 |
|
4 |
03/21/04 – 04/17/04 |
03/21/04 – 04/03/04 |
04/07/04 |
04/09/04 |
|
5 |
04/18/04 – 05/15/04 |
04/18/04 – 05/01/04 |
05/05/04 |
05/07/04 |
|
6 |
05/16/04 – 06/12/04 |
05/16/04 – 05/29/04 |
06/02/04 |
06/04/04 |
|
7 |
06/13/04 – 07/10/04 |
06/13/04 – 06/26/04 |
06/30/04 |
07/02/04 |
|
8 |
07/11/04 – 08/07/04 |
07/11/04 – 07/24/04 |
07/28/04 |
07/30/04 |
|
9 |
08/08/04 – 09/04/04 |
08/08/04 – 08/21/04 |
08/25/04 |
08/27/04 |
|
10 |
09/05/04 – 10/02/04 |
09/05/04 – 09/18/04 |
09/22/04 |
09/24/04 |
|
11 |
10/03/04 – 10/30/04 |
10/03/04 – 10/16/04 |
10/20/04 |
10/22/04 |
|
12 |
10/31/04 – 11/27/04 |
10/31/04 – 11/13/04 |
11/17/04 |
11/19/04 |
|
13 |
11/28/04 – 12/25/04 |
11/28/04 – 12/11/04 |
12/15/04 |
12/17/04 |
|
01 |
12/26-04 – 01/22/05 |
12/26/04 – 01/08/05 |
01/19/05 |
01/07/05 |
*ENDING PERIOD IS THE CHECK DATE
FOR EFT PAYMENTS, THE CHECK DATE WILL BE FRIDAY
|
DATE OF CHECK |
DISTRICT OFFICE CUT-OFF DATE |
N.O. TRANSMISSION TO |
|---|---|---|
|
TO ENTER DATA INTO ACPS |
||
|
EACH FRIDAY |
PREVIOUS TUESDAY |
WEDNESDAY |
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FECA BULLETIN NO. 04-03
Issue Date: January 5, 2004
Expiration Date: January 5, 2005
Subject: Employee "Authorized Providers" of Military Honors Funeral Support
Background: On January11, 2001, the Department of Defense (DOD) issued Directive 1300.15 setting forth a list of "authorized providers" who could serve as part of an honor guard for the purpose of rendering military funeral support to eligible beneficiaries, upon request. Further, the military services are encouraged to provide elements of honors and use additional uniformed members or other "authorized providers" to augment the funeral honors detail for this purpose. Included among the "authorized providers" are Veterans Service Organizations (VSO), members of the Reserve Officer Training Corps (ROTC) and other appropriate individuals and organizations that support the rendering of Military Funeral Honors.
Purpose: To provide guidance regarding the handling of claims of individuals rendering military funeral support as authorized providers.
Reference: FECA Procedure Manual Chapters 4-0600 and 2-0802; Title5U.S.C. 8140(a) and 8101(1)(B); 10U.S.C. § 1588(e)(4) of the Fair Labor Standards Act; and DODDirective 1300.15.
Applicability: All claims personnel in the National Office and the district offices.
Actions:
1. FECA coverage is afforded to members of ROTC, VSO, and other appropriate individuals and organizations ("authorized providers") which support the rendering of Military Funeral Honors. Authorized providers may complement a Military Funeral Honors detail by rendering additional elements of honors such as a firing party, pallbearers, bugler, or color guard, and the ceremonial folding and presentation of the American flag.
2. It is important for claims staff to note the distinction between coverage under 8101(1)(B) of the FECA as an "authorized provider" and "line of duty" coverage for ROTC members under 8140(a). "Authorized providers" are considered to be civil employees of the United States within the meaning of 5 U.S.C. 8101 (1)(B) when augmenting an Armed Forces Military Funeral Honors detail in accordance with 10 U.S.C. 1588(e). Section 8101(1)(B) refers to persons rendering service to the United States without pay or for nominal pay. As such, the pay rate of authorized providers of funeral honors support, including ROTC members, is determined in accordance with the provisions of 10U.S.C. 1588(d)(4).
3. All claims for benefits by "authorized providers," including ROTC, VSO members and other appropriate individuals and organizations, which support the rendering of military funeral honors, are to be jacketed, adjudicated and maintained in the district office that is local to the employee's duty station. After adjudication, the claimant's home address determines where further processing will occur. The only exception to this policy is where the claimant lives much closer to the DO serving the area of the duty station than to the DO serving the area of residence.
4. If OWCP receives a claim in which the claimant's status as an "authorized provider" is unclear, the CE should contact the appropriate military department, in writing, to ascertain the particular facts prior to the adjudication of the claim. The Secretary of a military department maintains the documentation supporting that an individual is recognized as an "authorized provider."
5. If the CE determines that further development is necessary, he or she must obtain documentation (for the case in the form of a certificate or other appropriate record) which recognizes the claimant as an "authorized provider" of military funeral honors support.
6. The pay rate for all "authorized providers" rendering military funeral honors support is the average monthly number of hours of services provided, times the then prevailing minimum wage under Section 6(a)(1) of the Fair Labor Standards Act, 10 U.S.C. § 1588(d)(4).
7. A brief training should held within 30 days of this issuance to ensure that appropriate practices are implemented.
Disposition: Retain until the indicated expiration date or until incorporated in the FECA Procedure Manual.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 1-Folioviews Groups A and D(Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialist and Staff Nurses)
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FECA BULLETIN NO. 04-04
Issue Date: January 16, 2004
Expiration Date: December 31, 2005
Subject: BPS - Revision in the Reimbursement Rates Payable for the Use of Privately Owned Automobiles Necessary to Secure Medical Examination and Treatment.
Background: Effective January 1, 2004, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile increased to 37.5 cents per mile by GSA. No restriction is made as to the number of miles that can be traveled. As in the past, determination has been made to apply the applicable rate to disabled FECA beneficiaries traveling to secure necessary medical examination and treatment.
Applicability: Appropriate National Office and District Office personnel.
Reference: Chapter 5-0204, Principles of Bill Adjudication, Part 5, Benefit Payments, Federal (FECA) Procedure Manual; Instructions for Submitting Form OWCP-957, Medical Travel Refund Request (For reimbursement of travel and related expenses under the Federal Employees' Compensation Act); and 5 USC 8103.
Action: Instructions for Submitting Form OWCP-957, Medical Travel Refund Request (For reimbursement of travel and related expenses under the Federal Employees' Compensation Act), has been revised to reflect the indicated rate change. A copy of the revised instructions is attached to this bulletin and may be reproduced at local levels. Vouchers being processed for travel periods after January 1, 2004 may be adjusted to reflect this increase.
Disposition: This Bulletin should be retained in Chapter 5 - 0404, Principles of Bill Adjudication, Federal (FECA) Procedure Manual.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 2 --- Folioviews Groups A and D (Claims Examiners, All Supervisors, Systems Managers, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal/Bill Pay Personnel)
Attachment
Instruction for Submitting Form OWCP-957
|
Instructions for Submitting Form |
U.S. Department of Labor |
|
--------------------------------------------------------------------------------------------------------------------------------------------- |
|
1. Claim for necessary and reasonable expense incident to travel authorized in accordance with provisions of the Federal Employees Compensation Act may be submitted for consideration on Form OWCP-957. Travel must be by shortest route and, if practicable, by public conveyance (streetcar, bus, boat, or train). Generally, 25 miles from the place of injury, the work site, or the employee's home, is considered a reasonable distance to travel.
2. The Office will promptly reimburse all bills received on the approved form and submitted in a timely manner. However, no bill will be paid for expenses incurred if the bill is submitted more than one year beyond the calendar year in which the expense was incurred or the service/supply was provided, or more than one year beyond the calendar year in which the claim was first accepted by the Office, whichever is later (20 CFR §10.803)
3. Payment will be made for taxicab fare or the hire of special conveyance where streetcars, buses, or other public and regular means of transportation are not available, except where these cannot be used because of the injured employee's disability. If claim is made for payment of expenses for taxicabs in excess of $75 or hire of special conveyances, prior authorization is required.
4. Reimbursement for transportation by automobile owned by an employee or a member of his/her immediate family or another Government employee may be claimed when no public conveyance is available or where the physical condition of the injured employee requires the use of special conveyance. Mileage expenses will be reimbursed at the GSA rate in effect on the date of travel. Mileage expenses will be reimbursed at the following rates for travel during the following periods:
| Dates | Rates |
|---|---|
|
January 1, 1995 to June 6, 1996 |
30.0 cents per mile |
If mileage expense is claimed prior to January 1, 1995, contact your OWCP district office for rates.
5. Claim may be made for parking fees. If travel must be over a toll route, toll charges may be claimed. The form must show the locations where travel began and ended and mode of travel. List each item of expense separately, showing the date incurred, place and cost of the travel.
6. There will be no reimbursement for meals or lodging when travel is for less than 12 hours in total or fewer than 500 miles round trip. If the authorized travel was for longer than 12 hours or greater than 500 miles, and a claim for meals or lodging is made, the dates and hours must be shown on the form. Lodging must receive prior authorization. All charges must be reasonable, and will be reimbursed at the per diem rate for the locality of travel. Any stopover or delay en route must receive prior authorization.
7. If several trips are covered by the same form, list each separately in the spaces provided on the form. Original itemized receipts for amounts in excess of $75 claimed in 5f, 6f and 7f must be furnished.
8. After a Form OWCP-957 has been completed, it must be signed in ink or indelible pencil in the space provided for the payee.
9. The completed form should be mailed to: U.S. Department of Labor, DFEC Central Mailroom, PO Box 8300, London, KY 40742-8300.
10. The form should not be submitted if there is no expense claimed.
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FECA BULLETIN NO. 04-05
Issue Date: May 16, 2004
Expiration Date: May 16, 2005
Subject: Adjudication of Claims - Federal Emergency Management Agency (FEMA) Disaster Assistance Employees (DAE).
Background: The Robert T. Stafford Disaster Relief and Emergency Act, P.L. 93-288, as amended, 42 U.S.C. 5121, et. seq. authorizes the FEMA to hire DAEs, by appointment affidavit (contract), to respond to disasters. DAEs have been defined as civil employees under the FECA (FECA PM 2-802). The duration of appointments range from 120 days to 24 months.
There are two types of DAEs: (1) reservists, who are hired on an on-call basis for a two month period, but who must be in a non-pay status for a minimum cumulative period of six months; and (2) local hires, who are hired for a period of 120 days. Both sets of employees are available for work during their respective appointment periods, but are only paid when called for active duty, e.g. travel assignments. As such, DAEs would be classified by OPM as temporary on call employees and would likely be afforded only limited qualified work in a year before a covered injury.
Purpose: To provide guidance on determining COP eligibility, the calculation of pay rates, and determining whether an election of benefits is needed (in the cases of re-employed annuitants) for FEMA DAE employees.
Reference: FECA Procedure Manual 2-807, 2-900, 2-1000-4(a), 20 C.F.R. 10.222(a) (5) and Title 5 U.S.C.8114 (d).
Applicability: All National Office staff and district office claims personnel.
Actions:
1. COP is available to DAEs throughout the course of their appointment period regardless of their "on call" status. Specifically, DAE reservists are on call for a two year period. Although they may not be in a pay status for the full on call period, FEMA instructions state that the reservist is "carried on FEMA personnel rolls for a 24 month period expiring September 30, of every even numbered year."
Accordingly, since reservists are considered employees of FEMA throughout the two year period, COP eligibility ends upon the expiration of that two year term, and not at the end of any period where the reservists might have been called up to active duty. Similarly, the 120 day local hires, though not necessarily in pay status during the 120 day period, are carried on FEMA personnel rolls for that entire period. Therefore, they are eligible for COP during the entire period of their temporary employment.
2. Due to the temporary nature of a DAE's work and the presumably limited, non guaranteed work opportunities available, the pay rate for most DAEs should be determined pursuant to 5 U.S.C 8114(d)(3) and the Federal (FECA) Procedure Manual 2-900-4(c). The claims examiner must establish the pay rate for compensation purposes through the calculation and comparison of (1) the worker's actual earnings throughout the year, including similar non-Federal employment; (2) the yearly earnings of similarly situated employees, using earnings information from such similarly situated employees working the greatest number of hours during the year prior to the injury, in the same or neighboring locality; and (3) the average daily rate of the DAE's regular daily pay schedule or the local prevailing wage rate for the local hires) multiplied by 150 ("150 times" formula). The highest of the three pay rate calculations is selected as the annual rate of pay (2-900-4(c) and is divided by 365 to compute the daily pay rate.
3. A DAE who qualifies as a re-employed annuitant must make an election of benefits between FECA and Office of Personnel Management (OPM) benefits. Section 8116(a) of the FECA requires a claimant who is entitled to FECA disability benefits and retirement benefits from OPM to make an election or choice of benefits. This includes OPM annuitants that have been re-employed while still receiving retirement benefits from OPM.
Disposition: Retain until the indicated expiration date or until incorporated in the FECA Procedure Manual.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 1-Folioviews Groups A and D (Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists and Staff Nurses)
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FECA BULLETIN NO. 04-06
Issue Date: May 16, 2004
Expiration Date: May 16, 2005
Subject: BPS-OWCP-915 - Medical Reimbursement Form and Instructions
Background: Effective March 31, 2004, new Form OWCP-915 should be submitted by all FECA recipients to claim medical reimbursement.
Reference: Federal (FECA) Procedure Manual Chapter 5-0200
Purpose: To notify all FEC staff of the new form to be used by FECA claimants for all reimbursements of medical expenses.
Applicability: Appropriate National Office and District Office personnel.
Action:
1. Effective March 31, 2004, in all cases where a request for the form used to make a claim for medical reimbursement is received; the requestor should be provided with Form OWCP-915, Claim for Medical Reimbursement. Form OWCP-915 is needed for processing requests for reimbursement of out of pocket work-related medical expenses including medical treatment, prescription medication and medical supplies. A copy of Form OWCP-915 is attached to this bulletin and may be reproduced at local levels. When a request for medical reimbursement is made on Form CA-915, the requestor should be advised that Form OWCP-915 is needed for all future medical reimbursement requests. Form OWCP-915 should be provided to the requestor when practical.
2. The instructions for using Form OWCP-915 are included on the reverse of the form and provide guidance for its completion by FECA recipients.
3. Form OWCP-915 should not be used to claim travel reimbursement. Claims for travel reimbursement should be submitted on Form OWCP-957.
4. The National Office will arrange for an initial supply of Form OWCP-915 to be provided to each District Office. The form and instructions will also be available on the DFEC website at http://www.dol.gov/esa/regs/compliance/owcp/forms.htm.
Disposition: This bulletin should be retained until incorporated in the Federal (FECA) Procedure Manual.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No.3-Folioviews Groups A, B, C and D (All FECA Employees)
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FECA BULLETIN NO. 04-07
Issue Date: July 23, 2004
Expiration Date: January 1, 2005
Subject: Compensation Pay: Compensation Rate Changes Effective January 2004.
Background: On March 4, 2004, the President signed a retroactive Executive Order implementing a salary increase of 2.70 percent in the basic pay for the General Schedule. The aplicability under 5 U.S.C. 8112 only includes the 2.70 percent increase in the basic General Schedule. Any additional increase for locality-based pay is excluded. The adjustment was made retroactive to an effective date of the first pay period after January 1, 2004.
Purpose: To inform the appropriate personnel of the increased minimum/maximum compensation rates, and the adjustment procedures for affected cases on the periodic death payrolls.
The new rates were effective with the first compensation payroll period beginning on or after January 1, 2004. The new maximum compensation rate payable is based on the scheduled salary of a GS-15, Step 10, which is now $113,674 per annum. The basis for the minimum compensation rate is the salary of $17,568 per annum (GS-2, Step 1).
The minimum increase specified in this Bulletin is applicable to Postal employees.
The effect on 5 U.S.C.8112 is to increase the payment of compensation for disability claims to:
|
Effective January 12, 2004 |
Minimum |
Maximum |
|---|---|---|
|
Monthly |
$1,098.00 |
$7,104.63 |
The effect on 5 U.S.C. 8133(e) is to increase the monthly pay on which compensation for death is computed to:
|
Effective January 12, 2004 |
Minimum |
Maximum |
|---|---|---|
|
Monthly |
$1,464.00 |
$7,104.63 |
Applicability: Appropriate National and District Office personnel
Reference: Memorandum for Directors of Personnel dated December 2003; and the attachment for the 2004 General Schedule.
Action: ACPS will update the periodic disability and death payrolls. Any cass with gross overrides will not have a supplemental record created. Thus, the cases with gross overrides must be reviewed to determine if adjustments are necessary. If adjustment is necessary, a manual calculation will be required.
1. Adjustments Dates.
a. As the effective date of the adjustment was January 11, 2004, and the new minimum,/maximum compensation rates were not established until March 4, 2004, a suplemental payment will be necessary for the periodic disability and death payrolls. For claims entitled to additional compensation due to the increased minimum/maximum rates, the supplemental payment will be dated May 28, 2004.
b. The new minimum/maximum compensation rates are available in ACPS.
3. Minimum and Maximum Adjustment Listings. Form CA-842, Minimum Compensation Pay Rates, and Form CA-893, Maximum Compensation Rates, should be annotated with the new rate information as follows:
|
CA-842 - 01/02/03 |
||||
|
50.68-76.02 |
253.38-380.10 |
50.68 |
253.38(1,013.52) |
1,464.00 |
|
CA-843 - 01/02/03 |
||||
|
327.91 |
1,639.53 (6,558.12) |
7,104.63 |
||
4. Forms. CP-150, Minimum/Maximum Compensation, were generated for each case adjusted. It should be noted that this adjustment process re-calculates EVERY ACPS record from very beginning to current date, thus, it may be that minor changes in the gross compensation are noted; this is not necessarily incorrect. Notices to all payees receiving periodic compensation payments were generated, informing them of potential changes to their compensation benefits.
Disposition: This bulletin is to be retained in Part 5, Benefit Payments Federal (FECA) Procedure Manual, until the indicated expiration date.
NANCY JENSON
Acting Director for
Federal Employees' Compensation
Infobases built before v3.1 have unreliable record IDs.
Distribution: List No. 2- - Folioviews Groups A and D (Claims Examiners, All Supervisors, Systems Managers, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal and Bill Pay Personnel)
Attachment FB 04-06 Medical Reimbursment Form - BPS-OWCP-915
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Attachment FB 04-06 Instructions for OWCP-915
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FECA BULLETIN NO. 03-01
Issue Date: January 16, 2003
Expiration Date: January 16, 2004
Subject: Compensation Orders/Letter Decisions - Signature Authority for Journey Level GS-12 and Senior Claims Examiners
Background: In the past, Senior Claims Examiners (SrCEs) exercised signature authority for most formal decisions. Since the office has upgraded journey level claims examiners (CEs) from a GS-11 to a GS-12, most formal decisions can now be prepared for the signature of the journey level GS-12 (general) CE.
The signature authority (approvals/denials) of GS 5-11 CEs is not affected by the contents of this bulletin or the attachment.
Reference: FECA Procedure Manual Chapter 2-807.10b, Chapter 2-808.7a, and Chapter 2-1400.2d.
Purpose: To advise claims staff of the changes in signature authority for some formal decisions.
Applicability: Claims Examiners, Senior Claims Examiners, Claims Suprevisors, Fiscal Officers, Technical Assistants, Hearing Representatives, and Hearing Examiners.
Actions:
1. Without written desisgnation from a Supervisory Claims Examiner (SCE) or higher authority, the signature authority outlined in this bulletin should not be delegated below the General GS-12 CE level.
2. The attachment should serve as a guide and/or reference with respect to signature authority and certification levels for GS-12 CEs (including seniors).
3. General CEs at the GS-12 level should exercise signature authority to deny the following: initial claims for traumatice injury and occupational disease; claims for recurrence; claims for continuation of pay (COP); requests for medical treatment, equipment, or supplies; requests for surgery; claims for schedule awards in hearing loss cases with no rateable loss; and periods of intermittent wage loss where the claimant has not met the burden of proof to establish entitlement to compensation.
4. GS-12 General CEs should adjudicate most complex disability and death cases.
5. General GS-12 CEs have signature authority to release Form CA-181, Award of Compensation when certifying a payment for a schedule award. (Note: Lump sum schedule award calculations must also be approved by a SCE.)
6. SrCEs are to have signature authority and responsibility for reconsideration decisions.
7. SrCEs are to have authority to approve and/or deny the full range of highly complex disability and death cases.
8. SrCEs are to have signature authority on preliminary notices of proposed reduction/termination of benefits, and for final decisions on reduction/termination of benefits.
9. Both the SrCEs and General GS-12 CEs are to have signature authority for no wage loss (zero LWEC) decisions based on the claimant's current employment.
10. After DD or ADD review, disallowances of disfigurement awards, should be prepared for the signature of the SrCE.
11. Disallowances, reductions and terminations not mentioned above should be prepared for the signature of the SrCE.
Disposition: Retain until incorporated in the Federal (FECA) Procedure Manual.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List no. 1-Folioviews Group A and D (Claims Examiners, All Supervisors, Systems Managers, District Medical Advisors, Technical Assistants, Rehabilitation Specialists and Staff Nurses)
Attachment FB 03-01-x1
SIGNATURE AUTHORITY (APPROVALS/DENIALS/CERTIFICATION)
General GS-12 CEs
* Traumatic Injury Claims
* Occupational Disease Claims
* Most Complex Disability and Death Cases
* Medical Treatment, Equipment, Supplies
* Surgery Requests
* Recurrences
* Non-Rateable Hearing Loss
* COP
* Intermittent Wage Loss
* Payment Certification ($0-15,000; including signature on CA-181 when certifying payment whithin prescribed limit) Note: Lump sum schedule award calculations must also be approved by a SCE.
* 0% LWECs
SENIOR CLAIMS EXAMINERS
* All items listed under General GS-12 CE
* All Complex Disability and Death Claims (approval/denial)
* Proposed Terminations & Final Terminations
* Proposed Reductions & Final Reductions
* LWEC Modifications
* 8106c Decisions; Rehabilitation Sanction Decisions
* Disallowance of Disfigurement Awards
* Suspension or Forfeiture of Benefits
* Rescission of acceptance
* Housing or Vehicle Modifications
* Reconsiderations
* Certification of Placement on the PR for TTD, LWEC or survivor benefits. Certification of OPM/VA Election Letters
* Certification authority $0-$50,000
SUPERVISORY CLAIMS EXAMINER OR HIGHER LEVEL
* Payments in amounts greater than $50,000 must be verified/signed by a Supervisory Claims Examiner (SCE), GS-13 or higher level. This authority may be delegated to a SrCE in writing for a specific period of time, for example while serving as acting SCE. The SrCE should relect such authorization in the case file by signing the payment as 'Acting SCE'
* SCE - Attorney Fees ($0-$50,000)
* DD or Add Attorney Fees > $50,000
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FECA BULLETIN NO. 03-02
Issue Date: January 27, 2003
Expiration Date: January 27, 2004
Subject: BPS - Revision in the Reimbursement Rates Payable for the Use of Privately Owned Automobiles Necessary to Secure Medical Examination and Treatment.
Background: Effective January 1, 2003, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile was reduced to 36.0 cents per mile by GSA. No restriction is made as to the number of miles that can be traveled. As in the past, this rate will also apply to individuals covered by the FECA who travel by POV in order to obtain necessary medical examination and treatment.
Applicability: Appropriate National Office and District Office personnel.
Reference: Chapter 5-0204, Principles of Bill Adjudication, Part5, Benefit Payments, Federal (FECA) Procedure Manual; Instruction CA-77, Instructions for Submitting Travel Vouchers; and 5 USC 8103.
Action: Instruction CA-77, Instructions for Submitting Travel Vouchers, has been revised to reflect the indicated rate change. A copy of the revised instructions is attached to this bulletin and may be reproduced at local levels. Vouchers being processed for travel periods after January 1, 2003 may be adjusted to reflect this decrease.
Disposition: This Bulletin should be retained in Chapter 5-0204, Principles of Bill Adjudication, Federal (FECA) Procedure Manual.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 2 -- Folioviews Groups A and D (Claims Examiners, All Supervisors, Systems Managers, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal/Bill Pay Personnel)
Attachment 1
Instructions for Submitting Travel Vouchers
Instructions for Submitting Travel VouchersU.S. Department of Labor (For reimbursement of travel and related expenses Employment Standards Administration under the Federal Employees' Compensation Act) Office of Workers' Compensation Programs
------------------------------------------------------------------------------------------------------------------------------------------
Note: Any item not in conformity with the following instructions and not legible will be deducted from the voucher. Both forms SF-1012 and SF-1012a MUST be submitted with a valid case file number.
1. Claim for necessary and reasonable expense incident to travel authorized in accordance with provisions of the Federal Employees Compensation Act may be submitted for consideration on Voucher Forms SF-1012 and SF-1012a. Travel must be by shortest route and, if practicable, by public conveyance (streetcar, bus, boat, or train).
2. The Office will promptly reimburse all bills received on the approved form and submitted in a timely manner. However, no bill will be paid for expenses incurred if the bill is submitted more than one year beyond the calendar year in which the expense was incurred or the service/supply was provided, or more than one year beyond the calendar year in which the claim was first accepted by the Office, whichever is later (CFR §10.803)
3. Payment will be made for taxicab fare or the hire of special conveyance where streetcars, buses, or other public and regular means of transportation are not available, except where these cannot be used because of the injured employee's disability. If claim is made for payment of expenses for taxicabs or hire of special conveyances, a full explanation must be made showing the necessity thereof.
4. Reimbursement for transportation by automobile owned by an employee or a member of his/her immediate family or another Government employee, may be claimed when no public conveyance is available or where the physical condition of the injured employee requires the use of special conveyance.
Mileage expenses will be reimbursed at the following rates for travel during the following periods:
| Dates | Rates |
|---|---|
|
January 1, 1995 to June 6, 1996 |
30.0 cents per mile |
If mileage expense is claimed prior to January 1, 1995, contact your OWCP district office for rates.
5. Claim may be made for parking fees. If travel must be over a toll route, toll charges may be claimed. The voucher must show the locations where travel began and ended, mode of travel, and name of the transportation company (if by public conveyance). List each item of expense separately, showing the date incurred, place, and cost of the travel.
6. There will be no reimbursement for meals or lodging when travel is for less than 12 hours in total. If the authorized travel was for longer than 12 hours, and a claim for meals or lodging is made, the dates and hours must be shown on the voucher. The necessity for lodging must be explained in detail. All charges must be reasonable, and will be reimbursed at the per diem rate for the locality of travel.
7. Any stopover or delay en route should be carefully explained. If several trips are covered by the same voucher, list each separately, indicate the purpose of each trip, and secure the approval of the attending physician, certifying that the dates are correct according to his/her records.
8. Original itemized receipts made out in factor of the person making payment, signed in ink or indelible pencil by the person receiving payment must be furnished for all items in excess of $75.00.
9. After a voucher SF-1012 has been completed, it must be signed in ink or indelible pencil in the space provided for the payee.
10. The travel voucher should not be submitted if there is no expense claimed.
INSTRUCTION CA-77
Revised January 2003
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FECA BULLETIN NO. 03-03
Issue Date: January 27, 2003
Expiration Date: January 27, 2004
Subject: ADP - Automated Compensation Payment System (ACPS) Schedule for 2003.
Purpose: To provide the 2003 schedule for processing the periodic disability and death payrolls under the ACPS for calendar year 2003.
Applicability: Appropriate National Office and District Office personnel that need to be aware of both the periods and "cut-off" dates for the ACPS periodic disability, death, and weekly payrolls.
Disposition: This Bulletin should be retained in front of Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until the indicated expiration date.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Attachment
Distribution: List No. 2 -- Folioviews Groups A and D (Claims Examiners, All Supervisors, Systems Managers, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal/Bill Pay Personnel)
Attachment
AUTOMATED COMPENSATION SYSTEM (ACPS) - 2003
Table to be inserted here!
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FECA BULLETIN NO. 03-04
Issue Date: March 7, 2003
Expiration Date: January 1, 2004
Subject: Compensation Pay: Compensation Rate Changes Effective January 2003.
Background: In December 2002, the President signed an Executive Order implementing a salary increase of 3.10 percent in the basic pay for the General Schedule. The applicability under 5 U.S.C. 8112 only includes the 3.10 percent increase in the basic General Schedule. Any additional increase for locality-based pay is excluded. The adjustment was effective the first pay period after January 1, 2003.
Purpose: To inform the appropriate personnel of the increased minimum/maximum compensation rates, and the adjustment procedures for affected cases on the periodic disability and death payrolls.
The new rates were effective with the first compensation payroll period beginning on or after January 1, 2003. The new maximum compensation rate payable is based on the scheduled salary of a GS-15, Step 10, which is now $110,682 per annum. The basis for the minimum compensation rate is the salary of $17,106 per annum (GS-2, Step 1).
The minimum increase specified in this Bulletin is applicable to Postal employees.
The effect on 5 U.S.C. 8112 is to increase the payment of compensation for disability claims to:
|
Effective January 2, 2003 |
Minimum |
Maximum |
|---|---|---|
|
Monthly |
$1,069.13 |
$6,917.63 |
The effect on 5 U.S.C. 8133(e) is to increase the monthly pay on which compensation for death is computed to:
|
Effective January 2, 2003 |
Minimum |
Maximum |
|---|---|---|
|
Monthly |
$1,425.50 |
$6,917.63 |
Applicability: Appropriate National and District Office personnel
Reference: Memorandum for Directors of Personnel dated December 2002; and the attachment for the 2003 General Schedule.
Action: ACPS will update the periodic disability and death payrolls. Any cases with gross overrides will not have a supplemental record created. Thus, the cases with gross overrides must be reviewed to determine if adjustments are necessary. If adjustment is necessary, a manual calculation will be required.
1. Adjustments Dates.
a. As the effective date of the adjustment was January26, 2003, no supplemental payroll was necessary for the periodic disability and death payrolls.
b. The new minimum/maximum compensation rates are available in ACPS.
2. Adjustment of Daily Roll Payments. Since the salary adjustments are not retroactive, it is assumed that all Federal agencies have ample time to receive and report the new pay rates on claims for compensation filed on or after January 1, 2003. Therefore, it is not necessary to review any daily roll payments unless an inquiry is received. If an inquiry is received, verification of the pay rate must be secured from the employing establishment.
3. Minimum and Maximum Adjustment Listings. Form CA-842, Minimum Compensation Pay Rates, and Form CA-843, Maximum Compensation Rates, should be annotated with the new rate information as follows:
|
CA-842 – 01/02/03 |
||||
|
49.34-74.01 |
246.72-370.05 |
49.34 |
246.72(986.88) |
1,069.13 |
|
CA-843 – 01/02/03 |
||||
|
319.28 |
1,596.38(6,385.52) |
|
6,917.63 |
|
4. Forms. CP-150, Minimum/Maximum Compensation, were generated for each case adjusted. It should be noted that this adjustment process re-calculates EVERY ACPS record from very beginning to current date, thus, it may be that minor changes in the gross compensation are noted; this is not necessarily incorrect. Notices to all payees receiving periodic compensation payments were generated, informing them of potential changes to their compensation benefits.
The notices were sent as an attachment to the Benefit Statement generated after each periodic cycle. Manual adjustments necessary because of gross overrides should be made on Forms CA-24 or CA-25 with a notice sent to the payee by the District Office.
Disposition: This bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until the indicated expiration date.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 2--Folioviews Groups A and D (Claims Examiners, All Supervisors, Systems Managers, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal and Bill Pay Personnel)
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FECA BULLETIN NO. 03-05
Issue Date: March 7, 2003
Expiration Date: February 29, 2004
Subject: Comp Pay/ACPS - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 2003.
Purpose: To furnish instructions on CPI adjustment implementation of March 1, 2003.
1. The new CPI increase, adjusted to the nearest one-tenth of one percent, is 2.4 percent.
2. The increase is effective March 1, 2003, and is applicable where disability or death occurred before March 1, 2002.
3. The new base month is December 2002.
4. The maximum compensation rates, which must not be exceeded, are the following:
| Rate | Time |
|---|---|
|
$ 6,917.63 |
per month |
Applicability: Appropriate National Office and District Office personnel.
Reference: FECA Consumer Price Index (CPI) Amendment, dated January 6, 1981.
Action: On or about March 14, 2003, both the periodic disability and death payrolls will be updated in ACPS. If there are any cases with gross overrides, there will be no supplemental record created. Thus, the cases with gross overrides must be reviewed to determine if CPI adjustments are necessary. If adjustment is necessary, a manual calculation will be required.
1. Adjustment Dates.
a. As the effective date of the CPI is March 1, 2003 and the start date of the periodic and death payroll cycles is February 23, 2003, there will be a supplemental record created for the period March 1 through March 22, 2003. Effective March 23, 2003, the periodic and death payrolls will reflect the increased amount.
b. The CA-816, LWEC, program will be updated with the new CPI percentage. This update will be performed for all district offices by the National Office.
2. Adjustments of Daily Roll Payments. Since the CPI will not be in ACPS until March 16, 2003, daily roll payment cases requiring the new CPI should be held for data entry until that date. ACPS RECORDS THAT REQUIRE ADJUSTMENT SHOULD NOT BE ENTERED BETWEEN MARCH 13, 2003 AND MARCH 17, 2003. ACPS data entry may resume on March 18, 2003.
3. CPI, Minimum and Maximum Adjustments Listings. Form CA-841, Cost-of-Living Adjustments; Form CA-842, Minimum Compensation Rates; and Form CA-843, Maximum Compensation Rates, should be updated with the new information. Attached to this directive is a complete list of all the CPI increases and effective dates since October 1, 1966 through March 1, 2003.
4. Forms.
a. Beginning with the compensation payment cycle that covers March 23, 2003 to April 19, 2003, the Office will issue an updated monthly Benefit Statement to each individual receiving benefits on the 28-day periodic roll cycle. This Benefit Statement will state the gross amount of compensation, the period of compensation covered by the statement, and the pertinent deductions made from the gross compensation. For compensation payments made via paper checks, the Benefit Statement will accompany the check. For compensation payments made through Electronic Fund Transfer (EFT), the Benefit Statement will be mailed separately.
b. Any manual adjustments necessary because of gross overrides in cases should be made on Form CA-24 or CA-25. A notice to the payee should be sent from the district office.
c. A CP-140 report will be printed for each case adjusted, upon specific request by a District Office.
d. If claimants write or call for verification of the amount of compensation paid (possibly for mortgage verification; insurance verification; loan application; etc.), please provide this data in letter form from the district office. Many times a benefit statement may not reach the addressee, and regeneration of the form is not possible. Thus, a simple letter indicating the amount of compensation paid every four weeks will be an adequate substitute for this purpose.
Disposition: This Bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until further notice or the indicated expiration date.
DEBORAH B. SANFORD
Director, Federal Employees' Compensation
Distribution: List No. 2 --Folioviews Groups A and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, and Rehabilitation Specialists)
Attachment
|
EFFECTIVE DATE |
RATE |
EFFECTIVE DATE |
RATE |
|---|---|---|---|
|
10/01/66 |
12.5% |
03/01/81 |
3.6% |
Prior to 09/07/74, the new compensation after adding the CPI is rounded to the nearest $1.00 on a monthly basis or the nearest multiple of $.23 on a weekly basis ($.23, $.46, $.69, or $.92). After 09/07/74, the new compensation after adding the CPI is rounded to the nearest $1.00 on a "periodic" basis or the nearest $.25 on a weekly basis ($.25, $.50, $.75, or $1.00).
| Date | Rate | ||
|---|---|---|---|
|
Prior to 11/1/74 |
.08-.34 = .23 |
Eff. 11/01/74 |
.13-.37 = .25 |
1 There was an error made by the Bureau of Labor Statistics (BLS) in calculating the CPI figure for 2000 and 2001 (see OMB Bulletin 01-04 for reference). The 2000 increase was erroneously reported as 2.7% instead of 2.8%, and the 2001 increase was reported as 3.4% instead of 3.3%. The OWCP issued a supplemental payment equivalent to 0.1% for all claimants entitled to CPI increases for the period of 03/01/00 to 02/28/01 to correct the shortfall. The initial CPI figures (2.7% and 3.4%) were originally kept in the system for consistency, rather than adjusting to the corrected BLS figures. However, in order to remain statistically correct, the figures have been adjusted this year to reflect the corrected BLS figures.
2 There was an error made by the Bureau of Labor Statistics (BLS) in calculating the CPI figure for 2000 and 2001 (see OMB Bulletin 01-04 for reference). The 2000 increase was erroneously reported as 2.7% instead of 2.8%, and the 2001 increase was reported as 3.4% instead of 3.3%. The OWCP issued a supplemental payment equivalent to 0.1% for all claimants entitled to CPI increases for the period of 03/01/00 to 02/28/01 to correct the shortfall. The initial CPI figures (2.7% and 3.4%) were originally kept in the system for consistency, rather than adjusting to the corrected BLS figures. However, in order to remain statistically correct, the figures have been adjusted this year to reflect the corrected BLS figures.
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FECA BULLETIN NO. 03-06
ISSUE DATE: May 9, 2003
EXPIRATION DATE: May 9, 2004
Subject: ADP - Code It Fast I-9 Coding Tool
Background: The International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is used in the Division of Federal Employees' Compensation (DFEC) to identify the condition(s) accepted by the program as compensable. The ICD-9-CM code(s) and the accompanying narrative description(s) are present in the case file itself, the Case Management File (CMF), and in documents to the claimant and provider(s). The accepted diagnoses are of importance in case management issues such as the appearance of additional conditions, consequential injuries, and length of disability. They are also necessary for the accurate processing of medical bills.
The ICD-9-CM classification is a hierarchical system of coding, with three digit category codes, followed in many instances by more specific four and five digit diagnosis codes that pinpoint the anatomical location and the particular nature of the disease or injury. This higher level of specificity is of benefit for case management purposes and is of particular importance in the Central Bill Processing System that will be implemented shortly.
To help facilitate the use of more specific codes, the Office of Workers' Compensation Programs (OWCP) has purchased an electronic medical coding tool known as Code It Fast I-9 (Code It Fast).
Code It Fast is a desktop application that enables the user to search and reference ICD-9-CM Volumes 1 and 3 from his or her desktop. It also provides the user with a tool that can be used to search for ICD-9 codes using narrative diagnoses or numeric code references. The program comes complete with Sticky Note and Bookmark features, and provides the same annotations and icons contained in the ICD-9 Coding books. The user's manual is available at http://www.ingenixonline.com/content/cifi9/. Online customer service is available at http://www.ingenixonline.com/content/techsupport/default.asp
Reference: FECA Bulletin 88-19 and 93-12.
Purpose: This bulletin will briefly describe some of the software features of the Code It Fast I-9 software, including logins and passwords.
Applicability: Claims staff, and medical staff in the district offices and the National Office, including the Branch of Hearings and Review.
Actions:
1. Code It Fast I-9 will be deployed to each user's desktop from the National Office. Users will receive notice of the availability of the program and the desktop icon will appear on their PC when available. The desktop icon should be used to access the program.
2. User Logins: Each time the user accesses Code It Fast, the User Login dialog box appears. A user name and password are required. Your user name must be at least 4 characters, but not more than 10 characters. Your user name and password can be saved for future logins by selecting save user name and password during login. Once logged in each user is uniquely identified and will have access to personal sticky notes and bookmarks. You can change your user password by selecting change user password from the file menu's administration option.
3. Performing a Code Search: The search box is used to enter search terms and narrow search results. The user can also type in a valid ICD-9 code in order to bypass the search and go directly to the tabular listing. Up to four key words or code numbers can be entered. Code It Fast searches all selected code set databases for a specific match based on the key words entered and the type of search option specified. Code It Fast also has an automatic spell check feature that ensures that the term entered is valid. If the search term is not valid, the search term alternative dialog box appears and alternative search terms are provided. The user's manual section entitled tips for entering search terms should be consulted for additional help in this area.
4. Viewing Search Results: After the user executes a search, the tabular results box displays matches found in all applicable code sets. The number of code matches found is referenced on the screen. Codes are displayed so that the most likely codes are listed first (by rank). Fourth and fifth digit ICD-9-CM codes are grouped under the primary code. CPT and HCPCS codes are grouped under the corresponding section or subsection. Matches to the search term results can be viewed in either the tabular listing or in the indexes for ICD-9-CM, CPT, and HCPCS codes.
Select the code from the tabular results box in order to view the full description. All neighboring codes in the adjacent tabular listing will also be displayed. The tabular listing also shows "excludes" and "includes" notes, as well as "code first" and "code also" references for ICD-9 Codes. CPT and HCPS codes in the tabular listing are grouped by section/subsection. This process is similar to looking up the code and the description in the ICD-9-CM, CPT, or HCPCS code book.
5. Code Specific Dialog Boxes for ICD-9-CM: This box can be used to view notes from the code book that specifically pertain to the selected code, and which provide further defining terms, clarifying information, and fifth digit information and includes and excludes notes. This box is accessed by selecting an ICD-9 code that has associated notes/references from the tabular listing. The user then clicks the notes button from the toolbar, or goes to the ICD-9 menu and selects ICD-9 section notes.
6. ICD-9 Annotations: From this dialog box one can view annotations that pertain to the code selected. Annotations provide explanations of medical terminology and descriptions for specific diseases or conditions. This box accessed by selecting an ICD-9-CM code that has an annotation from the Tabular Listing. Click either the Annotations button from the toolbar, or go the ICD-9 menu and select Annotations.
7. Additional Features:
a. The History Menu lists a trail of up to 15 previously viewed codes. This makes it easy to go back to a previous code selection during the current session.
b. The Bookmark Dialog Box is used to store, amend, and catalog lists of frequently used codes. To open the bookmark dialog box, click the bookmarks button, or select bookmarks from the view menu. The bookmark dialog box will not contain any codes when you first access the application. Once codes are added the bookmark dialog box will contain code number links which direct you to the appropriate code in the tabular listing. This feature also provides you with a description of the code and the category assigned when it was created. See the user's manual for more details on adding, editing and deleting bookmarks.
c. The user can copy codes, descriptions and modifiers into the Windows clipboard and paste them into other Windows applications. Code It Fast, provides two ways for copying information to the clipboard: Ctrl+C or the copy option under the edit menu. Either a code line or block of text must be selected before executing the copy command.
d. The user may add/edit comments to codes by using the sticky notes feature. Each code with a sticky note attached is flagged for user references. The Sticky Note dialog box is opened by either clicking the sticky note button on the main toolbar or selecting sticky notes from the view menu. As with bookmarking, sticky notes must be added to the dialog box. See the user's manual for details on adding, deleting or editing sticky notes.
e. To print the code information that appears in any dialog box, simply click the Print button or select Print from the File menu. The Print Report dialog box will appear. The user must select the items to be print, click the Setup button to display the Print Setup dialog box, and click the Print button. See the User's Manual for Print Report Options.
8. Code It Fast should be introduced to office staff prior to its deployment. Training on this bulletin may be conducted at the district office's discretion.
9. Updates to the Code It Fast software will be through National Office deployment when such become available.
10. The National Office will continue to assess the accuracy of ICD-9 coding.
Disposition: Retain until incorporated in the FECA procedural manual.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 2(Claims Examiners, All Supervisors, District Medical Director, Fiscal Personnel, Systems Managers, Technical Assistants and Rehabilitation Specialists)
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FECA BULLETIN NO. 03-07
Issue Date: May 12, 2003
Expiration Date: May 12, 2004
Subject: Development and Adjudication of Claims for War-Risk Hazard Cases
Background: The Federal Employees' Compensation Act (FECA) provides payment of compensation for disability or death of an employee resulting from an injury in the performance of duty. Section 8102(b) of the Act specifically extends coverage for injuries sustained by employees employed outside the continental United States or Alaska as a result of a "war-risk hazard." Terrorist activities will be considered a "war-risk hazard" if they are carried out by foreign groups (including terrorist groups) or foreign individuals targeting the United States or its allies. In view of various inquiries and concerns raised by other Federal agencies concerning terrorism, it is necessary to provide guidance and instruction to claims staff on handling claims that may arise under Section 8102 following a war-risk hazard.
A war-risk hazard is defined as a hazard arising during a war in which the United States is engaged; during an armed conflict in which the United States is engaged, whether or not war has been declared; or during a war or armed conflict between military forces of any origin, occurring within any country in which a covered individual is employed. The hazard may arise from any of the following: the discharge of a missile; action of a hostile force or person; the discharge or explosion of munitions; the collision of vessels in a convoy; or the operation of vessels or aircraft engaged in war activities. [See Section 8101(13) and FECA PM 4-0300.7c (1)–(5).] Section 8102(b)(2) of the Act provides that disability or death due to a war-risk hazard, or during or as a result of capture, detention, or other restraint by a hostile force or individual, sustained by an employee who is employed outside the continental United States or in Alaska constitutes a personal injury sustained while in the performance of duty. This applies whether or not the employee was engaged in the course of employment when the injury or death occurred or when he or she was taken hostage by the hostile force or individual.
A hostile force or individual means a nation, subject of a foreign nation or individual serving a foreign nation who is engaged in war or armed conflict as defined by the FECA.
Under section 8102 (b), an employee who resides in the vicinity of his employment who is not living there solely due to the exigencies of his employment is only covered while in the course of his employment. For example, local hires are covered only while in performance of duty. Also, Section 8102(b) does not apply to an employee who is a prisoner of war or a protected individual under the Geneva Conventions of 1949.
It should also be noted that Federal employees abroad are not covered around the clock under all situations. Federal employees abroad who are in travel status or on a special mission are covered for activities reasonably incidental to their employment (e.g., eating, sleeping, and transportation). Federal employees who are abroad may also be covered under other doctrines of workers' compensation law such as the zone of special danger, the bunkhouse rule, the proximity rule, the positional risk doctrine or the rescuers doctrine. In such situations, coverage would be extended on a basis other than Section 8102(b) where applicable to the facts of a given case.
References: Title 5 U.S.C. Sections 8102(b), 8101(13) defining war-risk hazard; 8101(14) defining hostile force or individual; 8101(15) defining allies and 8101(16) defining war activities and Federal (FECA) Procedure Manual Chapter 4-0300.7c (1)-(5). See also War Hazards Compensation Act, 42 U.S.C. 1701 et seq. using the same definition of war-risk hazard; regulations implementing the War Hazards Compensation Act at 20 CFR Part 61 and 62, and FECA Bulletin 91-14.
Purpose: To provide instructions and guidance to claims staff that are responsible for developing and adjudicating claims that arise under Section 8102(b) of the Act due to a war-risk hazard.
Applicability: All district office and National Office staff.
Responsibilities: Cases believed to fall under the provision of Section 8102(b) of the Act, i.e., war-risk hazard cases, should be jacketed, adjudicated and managed in the National Operations Office (District Office 25). Some cases may be forwarded to the servicing district office (DO) based on the claimant's home of record after adjudication. (See FECA PM 1-100.5 for case jurisdiction).
Action:
1. Claimant. A civilian employee or eligible dependent claiming compensation due to injury or death based on a potential war-risk hazard must provide sufficient information for OWCP to adjudicate the claim. A claimant may not necessarily identify a war-risk hazard as the basis of the claim and need not do so. Except for the issue of performance of duty, the evidence required is the same as in all other FECA claims.
2. Employing Agency Responsibilities.
a. Employing agencies are required to report to OWCP any injury resulting in death or probable disability, and to submit any additional information requested by OWCP. The employing agency is also expected to provide evidence on its own behalf and aid the claimant in assembling and submitting evidence. Timely reporting of such cases is especially important, as evidence relating to war-risk hazards is best gathered contemporaneously. Employing agencies are encouraged to flag such cases for possible development of a war risk hazard.
b. Since coverage under Section 8102(b) of the Act extends the boundaries of performance of duty to include activities that routinely fall outside the scope of employment, OWCP must look to the employing agency to investigate the circumstances of an injury and provide information so that a decision can be made in a timely manner.
c. The employing agency has a responsibility to the claimant to investigate and provide evidence promptly, and respond in writing and/or by telephone to any inquiries from OWCP within the timeframe requested. All telephone communications with other parties should be documented and placed in the case record. Employing agencies are encouraged to communicate in writing and/or by telephone with OWCP when they have additional evidence from other sources (i.e., third parties) that is pertinent to the development and adjudication of the claim. Such additional evidence should be shared with OWCP in an expeditious manner.
3. OWCP's Responsibilities.
a. The Claims Examiner (CE) must advise the claimant, the employing agency and/or the representative, if any, in writing of the type of evidence necessary to establish the claim. If appropriate, the examiner may advise the claimant that OWCP is considering extending coverage under 8102(b).
b. Information pertinent to the adjudication of the claim may be in the possession of the claimant, employing agency, investigative source and/or other governmental agency. If the CE determines that a third party is the best source for the information needed to adjudicate the claim, the employing agency should be contacted in order to ascertain whether the employing agency already has the evidence needed. If the employing agency does not have the evidence needed they should be instructed to obtain the evidence from the third party and submit it to OWCP. If appropriate, the employing agency may copy OWCP on any written correspondence to a third party. Alternatively, the employing agency should notify OWCP that such inquiries have been undertaken so that OWCP is aware of the employing agency's ongoing efforts to obtain additional evidence. If the employing agency is contacted by telephone the CE must document the case file with an Auto CA-110 and/or written correspondence when appropriate. All telephone requests for evidence needed to establish the claim should be confirmed in writing with copies to the claimant and/or the representative, if any.
c. In order to gather the information needed to establish whether coverage under Section 8102(b) of the Act should be extended, and whether the circumstances surrounding the occurrence of the injury constitute a war-risk hazard, the CE may ask the claimant, the representative (if any) and/or the employing agency specific questions concerning incidents leading up to, surrounding and following the injury. The questions will be detailed and case specific. They may include questions similar to the following:
(1) Please identify the location where the incident occurred in proximity to any United States governmental presence in the region, such as the United States embassy or other governmental entities, including the nature and extent of any United States military presence or the military presence of any allies of the United States. Is there armed conflict between military forces of any origin going on in the area?
(2) Were any other employees or witnesses from your department present on the date of the incident? Were any other federal employees or other individuals such as dependents injured in the incident?
(3) Does the employing agency know whether the CIA, FBI, or the State Department has any information as to whether the incident was the work of a foreign terrorist group or individual? (The term "terrorist group" refers to an identifiable organization or cause which uses violence to achieve political goals, and is considered a "hostile force or persons engaged in armed conflict." A "war-risk hazard" may therefore be present.)
(4) What general or specific warnings, if any, were given prior to the incident or have been subsequently given to personnel serving in the region regarding terrorist threats? Have any other incidents occurred which would indicate that United States personnel and/or citizens in the area have been targeted by any terrorist or terrorist groups?
(5) Does the claimant or employing agency have information that the incident occurred as the result of a war or armed conflict between military forces, or in a region within the country where civilian personnel are serving? Please identify the presence of any known military conflict in that country.
(6) Does the employing agency or the agency charged with investigating the incident (i.e., local police, FBI, CIA, State Department) have information about individuals responsible for the attack? Does the investigating agency know if the attackers were members of or acting on behalf of an identifiable group that pursues its political goals through the use of violence; or that has taken up arms against the United States or against the government where the incident arose? (In such cases, coverage would be extended.)
d. Cases that potentially fall under the provisions of Section 8102(b) of the Act due to a war-risk hazard are sensitive in nature. Therefore, it may be necessary to send a second or third request to obtain the requested evidence. If after a second request, the employing agency fails to respond, a telephone call should be made immediately by the CE to obtain the status of the request for information and to learn the reasons that are causing the delay. If the employing agency fails to respond after the third request, the CE should advise district office management. District office management is responsible for contacting the National Office immediately for guidance on handling the claim.
e. No adverse decision should be made until the National Office has been consulted.
f. The CE is responsible for rendering a decision on each case as promptly as possible. It is essential that development and adjudication be expedited on cases involving a war-risk hazard. However, decisions in these cases should not be expedited at the expense of obtaining all relevant evidence from all appropriate sources. Compensation payments should also be made as expeditiously as possible.
Disposition: Retain until the indicated expiration date or until incorporated in the FECA Procedure Manual.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution List: List No.1 Folioview Groups A and D (Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists and Staff Nurses)
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FECA BULLETIN NO. 03-08
Issue Date: May 23, 2003
Expiration Date: May 23, 2004
Subject: Medical Exams/IME: Board Certified Osteopathic Physicians in the PDS (Physicians Directory System)
Background: The OWCP policy of according special weight to the medical opinions of Board-certified specialists includes physicians certified by the American Osteopathic Association (AOA) as well as those certified by the American Board of Medical Specialties (ABMS). For some time there has been a question as to whether the special weight afforded by Board certification is equal among physicians who are certified by the ABMS and the AOA.
The original database for the Physician's Directory System (PDS), which OWCP uses for selecting referee physicians, was derived from the Directory of Medical Specialists published by Marquis Who's Who. This directory was compiled by the American Board of Medical Specialties (ABMS) which includes the medical boards of the American Medical Association that certify candidates in their respective fields of specialization.
In addition to the medical doctors (MDs) as described above, OWCP recognizes osteopathic doctors (DOs) as physicians within the meaning of the Act. OWCP also accords special weight to their opinions, provided they are Board-certified and it can be established that such certification has been verified with the American Osteopathic Association (AOA).
Reference: Federal (FECA) Procedure Manual, Chapters 2-810 and 3-0500.
Purpose: To further clarify OWCP's longstanding position that special weight is to be given to the opinion of a physician within the meaning of 5 U.S.C. 8101 who is Board-certified in an area of medical specialization; and to provide guidance to district office personnel with respect to adding osteopathic physicians to the PDS and selecting osteopaths for referee examinations.
Applicability: Claims Examiners, Senior Claims Examiners, All Claims Supervisors, Medical Schedulers, District Medical Directors, Technical Assistants, System Managers, Staff Nurses, and Vocational Rehabilitation Specialists
Action:
1. Adding Physicians to the PDS by the District Office Manager (PDS) administrator). since the original PDS database from Marquis Who's Who contained only MDs certified by the ABMS, there is currently no means of identifying DOs that have been added to the system. In order to remedy this situation, the following guidelines must be observed:
a. The PDS administrator must verify board-certification of all physicians entered into the PDS database (i.e, both DOs and MDs).
(1) In the case of DOs this must be done via the American Osteopathic Association (AOA), and not the State medicla board (which can only verify that a physician is licensed and in good standing to practice medicine in the particular state).
(2) To document board certification of all physicians added to the PDS, the PDS administrator will maintain a file for each physician which contaians copies of the curriculum vitae and the information verifying the board certification from either the ABMS or the AOA, which ever is apppropriate.
b. When a doctor who is a DO is added to the system, the PDS administrator must enter a note in the physician's note field indicating that this doctor is an osteopathic physician.
c. The DO's area of board-certification will be entered in the field where the area of specialization is normally entered.
d. If the DO has a sub-specialty it must be entered into the subspecialty field.
2. Modifying the PDS to include DOs as distinguished from MDs. If it is recognized that a DO has been added to the PDS without a means of distinguishing him or her from the larger body of MDs in the system, the PDS administrator must enter a note designating the physician as an osteopath and indicate the specialty and subspecialty just as in the guidelines at 1a., 1b. and 1c above. This will be the only means of identifying osteopathic physicians in the database until such time as upgrades to the system and modifications to the database are loaded.
The above described procedures will be effective within thirty (30) days of the release of this bulletin. Please ensure that proper notification/training is provided to district office personnel that are affected.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 1, Folioviews Groups A and D (Claims Examinres, All Supervisors, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)
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FECA BULLETIN NO. 03-09
Issue Date: July 7, 2003
Expiration Date: July 7, 2004
Subject: BPS - OWCP-957 – Medical Travel Refund Request Form and Instructions for Submitting OWCP-957
Background: Effective August 12, 2003, new Form OWCP-957 should be submitted by all FECA claimants to claim travel reimbursement.
Reference: Federal (FECA) Procedure Manual Chapter 5-0200
Purpose: To notify all FEC staff of the new form to be used by FECA claimants for all reimbursements of travel.
Applicability: Appropriate National Office and District Office personnel.
Action:
1. Effective August 1, 2003, in all cases where a request for the form used to make a claim for medical travel reimbursement is received; the requestor should be provided with Form OWCP-957. Form OWCP-957 is needed for processing requests for medical travel reimbursement through the automated bill processing system. A copy of Form OWCP-957 is attached to this bulletin and may be reproduced at local levels. When a request for medical travel reimbursement is made on a standard travel form (SF-1012), the requestor should be advised that Form OWCP-957 is needed for all future medical travel reimbursement requests. Form OWCP-957 should be provided to the requestor when practical.
2. Instructions for Submitting Form OWCP-957, Medical Travel Refund Request, provide guidance for completion of Form OWCP-957 by FECA recipients. A copy of the instructions is also attached to this bulletin.
3. The National Office will arrange for an initial supply of Form OWCP-957 to be provided to each District Office. The form and instructions are available on the DFEC website at http://www.dol.gov/esa/regs/compliance/owcp/forms.htm.
Disposition: This bulletin should be retained until incorporated in the Federal (FECA) Procedure Manual.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 3 - Folioviews Groups A, B, C and D (All FECA Employees)
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FECA BULLETIN NO. 03-10
Issue Date: June 13, 2003
Expiration Date: June 12, 2004
Subject: Fiscal - Change of Lockbox Depository Effective March 19, 2003
Background: In March 2003, the U.S. Treasury/Financial Management System (FMS) severed its ties with PNC Bank of Pittsburgh, PA. As a result, the current DFEC lockbox accounts were cancelled, requiring a new depository. FMS has since negotiated new agreements for the affected lockbox depository accounts with Bank of America in Atlanta, Georgia.
Purpose: To inform the appropriate personnel of the change in lockbox depository addresses, ensuring the proper processing of all incoming cash receipts.
Applicability: Appropriate National and District Office personnel. This includes each district office that previously had a lockbox account with PNC Bank. All DFEC lockboxes with an account apart from PNC Bank are not affected by this change, and their depository accounts remain the same. The current list of all DFEC lockboxes is attached to this publication.
Action:
1. All letters requesting payment to be mailed directly to the lockbox depository should be changed immediately. All letters pertaining to overpayment decisions (CA-2223, CA-2225, and the CA-9000 series) should be changed at each district office to reflect the new address as detailed in the attached listing.
2. DFEC System Managers have already been notified of the needed address change via e-mail, and should have modified the district office's "v44_lb_addr table." This update will also automatically update the Letter Generator System (LGS), since the LGS retrieves the lockbox addresses from this part of the v44 table through the "letters.cgi" when the "Generate Letter" button is clicked.
3. All other appropriate district office personnel must be made aware of the local lockbox address change.
4. As deposits sent to the old lockbox at PNC Bank will only be forwarded to Bank of America for approximately six months, the district offices affected must make every effort to inform any individual or organization that is sending cash deposits to the lockbox. This includes notifying entities such as medical providers and claimants with overpayments of the applicable address change.
5. All deposits mailed from the district office to the lockbox after March 19, 2003 should be mailed to the new lockbox address at the Bank of America.
6. It will also be necessary for each district office to identify all Office of Personnel Management (OPM) and salary offsets that are currently being mailed directly to its lockbox. The Cash Receipts Register will serve as a source for quick identification of such deposits. Notices must be sent to OPM and/or the employing agency immediately.
7. Deposit transactions will be made in the same manner as those previously made with PNC Bank. Transactions data will be sent from Bank of America to the district offices via FedEx. "Zero Activity" reports from Bank of America will not be forwarded, only daily reporting with actual deposit activity. The date of deposit will continue to be the Treasury confirmation date.
The contact person at Bank of America is Linda Thomas. Ms. Thomas can be reached by telephone at (770) 774-6430, and by e-mail at linda.j.thomas@bankofamerica.com.
Disposition: This bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until the indicated expiration date.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 2--Folioviews Groups A and D (Claims Examiners, All Supervisors, Systems Managers, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal and Bill Pay Personnel)
LOCKBOX DEPOSITY ADDRESSES
The following is a listing of the current mailing addresses for all DFEC lockboxes. This listing has been revised to include the new addresses for all lockboxes that have been switched from PNC Bank to Bank of America. All other district office lockbox addresses remain unchanged.
Boston District Office:
U.S. Dept. of Labor – DFEC Boston
P.O. Box 403498
Atlanta, GA 30384-3498
New York District Office:
U.S. Dept. of Labor – DFEC New York
P.O. Box 403484
Atlanta, GA 30384-3484
Philadelphia District Office:
U.S. Dept. of Labor – DFEC Philadelphia
P.O. Box 403471
Atlanta, GA 30384-3471
Jacksonville District Office:
U.S. Dept. of Labor – DFEC Jacksonville
P.O. Box 403376
Atlanta, GA 30384-3376
Cleveland District Office:
U.S. Dept. of Labor – DFEC Cleveland
P.O. Box 403459
Atlanta, GA 30384-3459
Chicago District Office:
U.S. Dept. of Labor – DFEC Chicago
P.O. Box 403449
Atlanta, GA 30384-3449
Kansas City District Office:
U.S. Dept. of Labor
Kansas City FECA Office
P.O. Box 845038
Dallas, TX 75284-5038
Denver District Office:
U.S. Dept. of Labor
Denver FECA Office
P.O. Box 60000
San Francisco, CA 94160-1251
San Francisco District Office:
U.S. Dept. of Labor
San Francisco FECA Office
P.O. Box 60000
San Francisco, CA 94160-1251
Seattle District Office:
U.S. Dept. of Labor
Seattle FECA Office
P.O. Box 60000
San Francisco, CA 94160-1252
Dallas District Office:
U.S. Dept. of Labor
Dallas FECA Office
P.O. Box 843537
Dallas, TX 75284-3537
Washington D.C. District Office:
U.S. Dept. of Labor – DFEC Washington D.C.
P.O. Box 403431
Atlanta, GA 30384-3431
National Office:
U.S. Dept. of Labor – DFEC National Office
P.O. Box 403356
Atlanta, GA 30384-3356
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FECA BULLETIN NO. 03-11
Issue Date: August 29, 2003
Expiration Date: August 29, 2004
Subject: Forms – Foreign Payment Worksheet
Background: Foreign nationals are entitled to full medical benefits, including a choice of qualified physicians. Often, because of remote or undeveloped locations, employees will be treated at a Federal medical facility or may be transported to another country for treatment. Bills which have been approved for payment and in which payment is to be made to a foreign address must be forwarded to the National Office (District 50) for manual processing. All foreign bills, even those requesting reimbursement in U.S. dollars, will be sent to the National Office for payment, and should not be processed through the automated system.
Reference: FECA Procedure Manual, Chapter 4-0801-8(b)(2)
Purpose: To notify all employees of the existence of the new Foreign Payments Worksheet, and provide revised procedures for the handling of foreign bills.
Applicability: All staff.
Actions:
1. Processing Payments: All foreign payments that are received at the district office must be reviewed prior to submission to the National Office for payment. When it has been determined that the submission contains all appropriate information, the responsible claims staff at the district office must then compete Items 1–11 of the Foreign Payments Worksheet (Attachment 1). Particular attention should be paid to detailing the specifics of the payment request in Box 9 of the form. It is noted that all bills submitted for claimants residing in Germany will be paid as reimbursements directly to the claimant, due to strict German bill pay laws.
Once complete, the individual completing the form should initial the Worksheet in Box 10 of the form, and attach the Worksheet to the original source documents that generated the payment request. The entire packet should then be forwarded to the responsible Claims Examiner (CE) assigned to the claim for certification. The CE has the responsibility to ensure that the submitted bills are in fact payable for that claim, and that the information listed on the Worksheet is accurate. Once certified by the CE, the entire packet should be forwarded to the appropriate staff for local imaging. The packet should be categorized as "Incoming Correspondence and Calls" in OASIS, with the attached Worksheet acting as the first page of the document. This will allow the image(s) to serve as a record of any foreign bills pending processing at the National Office.
The Worksheet should then be forwarded to National Office for payment processing. In order to confirm the accuracy of the data on the completed Worksheet, the National Office should review the submitted bills in the OASIS case record. The National Office will complete the SF-1166, and submit it to the Kansas City Financial Management Center (KC/FMS) for payment.
When the payment has been confirmed by KC/FMS, National Office staff will complete Items 12-17 of the Worksheet, detailing the payment specifics. A Foreign Payment Notification will then be sent to the claimant, indicating that payment is forthcoming and specifying the payment details (Attachment 3). A completed copy of the Worksheet, Foreign Payment Notification letter, and associated payment voucher from the KC/FMS will be sent to the ACS Central Bill Pay staff to update the bill history and then image as a paid bill.
2. Incomplete Payment Requests: If the district office staff cannot determine all the necessary specifics of a foreign payment request, they will immediately return the bills to the claimant. Attached to the bills will be the Foreign Bill Return letter (Attachment 2), explaining that the submitted bills cannot be paid due to the fact that key elements of the payment request cannot be identified. The letter will ask the claimant to provide the information necessary to pay the medical provider. In addition, a Form CA-915 (Claimant Medical Reimbursement Form) will be included in the return packet, to allow the claimant to provide the necessary information to allow reimbursement of expenses paid.
Disposition: Retain until incorporated in the Federal (FECA) Procedure Manual.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 2 - FolioViews Groups A and D (Claims Examiners, All Supervisors, Systems Managers, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal and Bill Pay Personnel)
Attachment 1
Foreign Payment Worksheet
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Attachment 2
Letter With Enclosed Bills recently Submitted
Claimant:
File Number
DATE
CLAIMANT NAME
STREET ADDRESS
CITY
COUNTRY
Dear Claimant:
The enclosed bills were recently submitted to our office in connection with your workers' compensation claim. However, additional information is required before the bills can be paid. Please provide the information needed on the lines provided below.
PLEASE NOTE: If you are seeking reimbursement of medical expenses already paid by you, please complete the enclosed Form CA-915.
If there are any questions concerning your claim or this form, please contact the Office at (XXX) XXX-XXXX.
Sincerely,
Claims Examiner
Claimant:
File Number:
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Attachment 3
Letter - Total Payment
DATE
CLAIMANT NAME
STREET ADDRESS
CITY
COUNTRY
TOTAL PAYMENT:
Within the next several weeks, the U.S. Treasury will send a check to you at the address noted above. When received, the check will represent payment of the medical expenses that were recently submitted to our office for payment. The check will be issued in the foreign currency indicated on the bill(s).
If the bill(s) have been paid by you, please accept the check as your reimbursement; if the bill(s) have not been paid, please ensure that the appropriate medical provider(s) are paid upon receipt of the check.
If you have incurred additional medical expenses as a result of your employment-related injury, you may submit the bills to our Central Mail facility at the following address: DFEC Central Mailroom, P.O. Box 8300, London, KY 40742. Please be sure to include your claim file number (as shown on the top of this letter) on each item submitted, along with your current mailing address.
Sincerely,
Special Examiner
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FECA BULLETIN NO. 03-12
Issue Date: September 26, 2003
Expiration Date: September 26, 2004
Subject: BPS - Operational Guidelines for the Central Bill Processing system
Background: Effective September 2, 2003, OWCP began providing centralized bill processing (including most bill resolution/adjustment) for all of its DFEC district offices through Affiliated Computer Services (ACS). On August 13, 2003 ACS began to receive point-of-sale pharmacy bills. ACS is also providing medical authorization services. Bills should be mailed to: U.S. Department of Labor, DFEC Central Mail Room, P.O. Box 8300, London, KY 40742-8300. All bills should be sent directly to London, KY except foreign currency bills, bills for field nurse or rehabilitation counselor services, bills for OWCP directed medical examinations and bills for DMA review. Bills from contract nurses and rehabilitation counselors should be submitted electronically through the ACS web-portal.
Reference: Current version of the District Office Operational Rules and Processing Information document.
Purpose: To provide operating procedures for centralized bill processing.
Applicability: Claims Examiners, Senior Claims Examiners, All Claims Supervisors, Medical Schedulers, District Medical Advisors, Technical Assistants, System Managers, Staff Nurses, Vocational Rehabilitation Specialists, Communications Specialists, Fiscal Operations Specialists, Medical Coding Specialists, and Customer Service Representatives
Action:
1. Prior medical authorizations will be provided via telephone call and written correspondence to ACS. Written medical authorizations will be mailed or transmitted to London, KY and scanned into both OASIS and SIR (Storage Information Retrieval) (SIR is the image system used by ACS).
a. ACS will continue to categorize all incoming mail; however, when a piece of mail is determined to be an authorization request, ACS will add a subject index in the OASIS file. This additional indexing will notify the claims examiner (CE) that ACS has processed that document as a medical authorization request, and the document has been imaged into SIR and reviewed by the prior authorization department in Tallassee.
b. If ACS needs to contact the district office regarding a written authorization request or a phone request, the responsible CE will receive an Omni-track thread from ACS concerning the requested medical service. The training material from ACS includes instructions on the use of Omni-track and the Prior Authorization process.
2. The toll free contact number for providers and claimants regarding medical billing is (866) 335-8319. This number should also be used to obtain a medical authorization. For faster service regarding medical bill inquiries, providers, claimants, and employing agencies may obtain information on-line at the OWCP web bill portal. Medical authorizations should be faxed to ACS for processing at (800) 215-4901.
3. Appropriate FEC personnel are to refer all pharmacy calls to ACS or to the web-site. If the pharmacy calls the district office regarding a medication that is not payable under the new system (and the pharmacy has already talked to ACS), the district office should state that the pharmacy cannot pursue the issue for the claimant any further. The pharmacy should be told that the issue is now a matter to be resolved between the treating physician and the CE. If the medication has been rejected by the treatment suite the CE should refer the request to the DMA for review of the medication and its use for treatment of the accepted condition(s). If the DMA opines that the medication is needed for treatment of the accepted condition the issue should be directed to the National Office, through the District Director, to determine if modification of the treatment suite is needed.
4. All staff nurses (SN) and vocational rehabilitation specialists (RS) should receive training on web-bill processing. The SN and RS will be responsible for reviewing and approving bills and reports submitted via the web-portal. The bills will be submitted to ACS for processing through the web-portal by the SN and RS. All field nurses and vocational rehabilitation counselors will need to enroll as providers with ACS. They will also need to sign a web-billing agreement form in order to log onto the web-portal and submit bills.
5. The toll free number for ACS will direct the caller to an IVRS that will be maintained by ACS. The caller, with the proper identifying information, will be able to access information about bill submission, prior authorization, and bill payment. The caller will be led through a series of menu options, designed to handle routine calls and inquiries, prior to being provided an option to speak with a customer service representative. Access to information will be limited in volume and time. The caller will be informed that the web-site is a better tool for gathering information several times throughout the call.
6. Effective immediately all GTRs submitted for payment should be forwarded to the National Office fiscal officer for processing.
7. All payments for 100% wage loss due to the claimant's attendance at an OWCP directed medical examination should be processed through ACPS as a direct payment. If the case is under development or is in a denied status, a certification memorandum should be faxed to the National Office fiscal officer at (202) 693-1498.
8. Each district office should conduct training for its employees within 30 days of the issuance of this bulletin. It is recommended that employees receive training only on the systems they will specifically use to perform their duties.
Disposition: Retain until incorporated into the FECA Procedure Manual.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 3 Folioviews Groups A, B, C, and D (All FECA Employees)
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FECA BULLETIN NO. 02-02
Issue Date: March 1, 2001
Expiration Date: February 28, 2002
Subject: Comp Pay/ACPS - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 2001.
Purpose: To furnish instructions for implementing the CPI adjustments of March 1, 2001.
1. The new CPI increase, adjusted to the nearest one-tenth of one percent, is 3.4 percent.
2. The increase is effective March 1, 2001, and is applicable where disability or death occurred before March 1, 2000.
3. The new base month is December 2000.
4. The maximum compensation rates, which must not be exceeded, are the following:
| Amount | Time |
|---|---|
|
$ 6,476.44 |
per month |
Applicability: Appropriate National Office and District Office personnel.
Reference: FECA Consumer Price Index (CPI) Amendment, dated January 6, 1981.
Action: On or about March 14, 2001, both the periodic disability and death payrolls were updated in ACPS. No supplemental record was created for cases with gross overrides. Thus, the cases with gross overrides must be reviewed to determine if CPI adjustments are necessary. If adjustment is necessary, a manual calculation will be required.
1. Adjustment Dates.
a. As the effective date of the CPI is March 1, 2001 and the start date of the periodic and death payroll cycles was February 25, 2001,a supplemental record was created for the period March 1 through March 24, 2001. Effective March 25, 2001, the periodic and death payrolls reflect the increased amount.
b. The CA-816, LWEC, program has been updated with the new CPI percentage. This update was performed for all district offices by the National Office.
2. CPI, Minimum and Maximum Adjustments Listings.
Form CA-841, Cost-of-Living Adjustments; Form CA-842, Minimum Compensation Rates; and Form CA-843, Maximum Compensation Rates, should be updated with the new information. Attached to this directive is a complete list of all the CPI increases and effective dates since October 1, 1966 through March 1, 2001.
3. Forms.
a. The benefit statement sent to each individual receiving benefits on the 28-day periodic roll for the roll cycle from March 25, 2001 to April 21, 2001 has been updated. The benefits statement provides the gross amount of compensation, the period of compensation covered by the statement, and the pertinent deductions made from the gross compensation. For compensation payments made via paper checks, the benefit statement will accompany the check. For compensation payments made through Electronic Fund Transfer (EFT),the benefit statement will be mailed separately.
b. Any manual adjustments necessary because of gross overrides should be made on Form CA-24 or CA-25. A notice to the payee should be sent from the district office.
c. A CP-140 report will be printed for each case adjusted, upon specific request by a district office.
d. If claimants write or call for verification of the amount of compensation paid (possibly for mortgage verification; insurance verification; loan application; etc.), please provide this data in letter form from the district office. Many times a benefit statement may not reach the addressee, and regeneration of the form is not possible. Thus, a simple letter indicating the amount of compensation paid every four weeks will be an adequate substitute for this purpose.
Disposition: This Bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until further notice or the indicated expiration date.
DEBORAH B. SANFORD
Director, Federal Employees' Compensation
Attachment
Distribution: List No. 2 --Folioviews Groups A and D(Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, and Rehabilitation Specialists)
|
EFFECTIVE DATE |
RATE |
EFFECTIVE DATE |
RATE |
|---|---|---|---|
|
10/01/66 |
12.5% |
09/01/80 |
4.0% |
Prior to 09/07/74, the new compensation after adding the CPI is rounded to the nearest $1.00 on a monthly basis or the nearest multiple of $.23 on a weekly basis ($.23, $.46, $.69, or $.92). After 09/07/74, the new compensation after adding the CPI is rounded to the nearest $1.00 on a "periodic" basis or the nearest $.25 on a weekly basis ($.25, $.50, $.75, or $1.00).
| Date | Rate | Date | Rate |
|---|---|---|---|
|
Prior to 11/1/74 |
.08-.34 = .23 |
Eff. 11/01/74 |
.13-.37 = .25 |
District Office
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FECA BULLETIN NO. 02-03
Issue Date: January 31, 2002
Expiration Date: January 30, 2003
Subject: Case Management -Authorization of Physical Therapy
Background: Physical therapy is one of the most common medical services authorized under the Federal Employees' Compensation Act (FECA). Nearly 25% of injured federal workers receive at least one physical therapy modality as part of their treatment. During FY 2000, physical therapy dollars constituted 13% of all medical outlays.
Currently, cases with physical therapy costs exceeding $8,000.00 per year make up 1% of all cases in which therapy is authorized. However, this 1% of cases is responsible for 11% of the total physical therapy costs paid under the FECA.
Reference: FECA Procedure Manual Chapter 2-810-16.
Purpose: To establish clear guidance on the proper authorization of physical therapy services and to transmit new procedures for the regular review of high cost physical therapy cases.
Applicability: Claims Examiners, Senior Claims Examiners, Claims Supervisors, Staff Nurses, Fiscal Officers, Technical Assistants, Bill Resolution Staff, Hearing Representatives, and Hearing Examiners.
Action:
Initial Authorization of Physical Therapy
1. Physical therapy that is prescribed by the attending physician and performed within the first 120 days followingthe date of injury (DOI), date of authorized surgery or date of accepted recurrence should be approved if the accepted medical condition(s) warrants it, i.e. orthopedic or neurologic condition accepted. The claimant should be notified via acceptance letter of the period during which physical therapy services are authorized. The CE must be specific regarding the dates during which physical therapy is authorized.
a. The occupational disease acceptance letter, CA-1008OD found in the DFEC Letter Generation System under the Acceptance and Medical Authorization/Denial category, has been modified to require the inclusion of specific dates during which physical therapy treatment is authorized if that option is selected. The CA-1008 for traumatic injury claims was not modified. It continues to include an optional paragraph stating that physical therapy is authorized for a period of up to 120 days from the date of injury.
b. A recurrence acceptance letter has been added to the DFEC Letter Generation System under the Acceptance and Medical Authorization/Denial category. This letter contains an optional paragraph to authorize physical therapy and requires the inclusion of specific dates during which the services are authorized.
c. The letter authorizing surgery, CA-6059 found in the DFEC Letter Generation System under the Acceptance and Medical Authorization/Denial category, has been modified to address the authorization of physical therapy services and requires the inclusion of specific dates during which the services are authorized.
1. Physical therapy services provided during the first 120 days following the DOI for a traumatic injury or occupational disease, with an appropriate accepted medical condition, will continue to be processed for payment without CE intervention. The CE must enter the authorized 120 day period in screen #34, PHYSICAL THERAPY AUTH of the Case Management File (CMF) for accepted recurrences, periods following authorized surgery or any other events that fall outside of the 120 days from the DOI window. As a rule, previous authorization periods should not be overwritten or removed. If more than two authorization periods are required, the CE should overwrite the older period. However, this overwritten period must be entered into screen #12, NOTE of the CMF.
2. Extended physical therapy may be approved for severe brain or spinal cord injuries, extensive second or third degree burns or other severe injuries that have rendered the claimant bedridden permanently or for an extended period of time. The CE may authorize physical therapy services for up to one year in these circumstances. However, the accepted condition(s) must support this exception.
Physical Therapy Requests After the Initial Authorization Period
1. Physical therapy should not be routinely authorized for periods longer than 120 days when the accepted conditions are sprains and strains or other self-limiting musculoskeletal conditions.
2. When physical therapy is requested beyond the initial 120 day period, the CE should evaluate the evidence of record and the projected period and frequency of the additional physical therapy request based on the guidelines described in PM 2-0810-16.e. The CE may wish to utilize the district medical advisor (DMA) in assessing the medical evidence.
3. Prior to authorization of any additional physical therapy, the file must contain medical evidence that provides the following:
a. Diagnosis for which physical therapy will be administered.
b. Specific functional deficits that are to be treated, including a description of how these affect the patient's physical activities.
c. Specific functional goals of the additional therapy.
d. Expected duration and frequency of treatment.
e. Modalities, procedures and/or tests and measures to be administered as detailed by the Physicians' Current Procedural Terminology (CPT) codes.
f. Appropriateness of a patient-directed home exercise program as an alternative to supervised physical therapy.
4. Necessary medical development may be undertaken in one of the following ways:
a. Release of a physical therapy development letter to the treating physician. The DFEC Letter Generation System contains letter CA-6021 for this purpose. (This letter has been revised and is found in the Development/Medical Category of the Letter Generation System.) Both the claimant and physical therapy provider should be copied when the development letter is sent.
b. Second opinion evaluation.
c. Development by a Field Nurse (FN) if one is currently assigned.
5. If the medical evidence of record clearly supports the additional period, or a minimal (less than two week) period of additional therapy is requested, the CE may authorize additional physical therapy for the period requested or 90 days, whichever is less.
6. Authorization for additional physical therapy treatment must not be granted and no further physical therapy can be paid until the development of this issue is complete.
Assessment of Medical Evidence
1. The CE should review the evidence obtained to determine if the requested period of PT is deemed appropriate. Section 5 U.S.C. 8103 of the Federal Employees' Compensation Act (FECA) permits approval of services "likely to cure, give relief, reduce the degree or period of disability, or aid in lessening the amount of the monthly compensation". For most cases, 120 days of physical therapy is sufficient to satisfy the requirements of section 8103. For requests exceeding this amount of treatment, the CE is charged with ensuring the medical evidence contained in the file justifies how the additional physical therapy will benefit the injured worker within the parameters of section 8103. The evidence should be sufficient to allow an independent reviewer to ascertain the specific nature of the expected cure, relief or reduction in disability. The medical evidence should be assessed critically to ensure it clearly supports not only the benefits of the expected therapy, but the specific extent and duration of the additional treatment.
2. In determining the need for additional therapy the CE should weigh the medical evidence using the following criteria:
a. The physical therapy is directed to the accepted condition or to an accepted complication of this injury or condition, including surgery; and
b. The specific modalities, procedures and/or tests and measures include some form of active physical therapy as evidenced by the use of any of the following CPT codes: 97110 through 97116 (therapeutic exercises); 97240 through 97241 (pool therapy or Hubbard tank); 97500 through 97541 (orthotics, prosthetics and activities of daily living training); and
c. A functional deficit exists and the additional therapy is expected to produce some functional improvement. Pain alone does not constitute a functional deficit. To authorize additional physical therapy for pain, the CE should ensure that the pain is associated with measurable objective findings such as muscle spasm, atrophy and/or radiologic changes in joints, muscles or bones, or that pain has placed measurable limitations upon the claimant's physical activities.
Approving Additional Physical Therapy
1. If medical justification for additional physical therapy is sufficient, the CE should issue a letter indicating the specific period of authorization. The CE should notify the claimant, the treating physician and the physical therapy provider of the specific period of the extension. CA-6021 in the DFEC Letter Generation System can be used for this notification.
2. If the authorized period is shorter than the period requested, the letter should explain the basis for the limited authorization.
3. The additional period of authorized physical therapy treatment should not exceed 90 days.
4. The CE must update screen #34 in the CMF with the additional authorized period of physical therapy.
Denying Additional Physical Therapy
1. If the medical evidence of record is not sufficient to support the need for additional physical therapy, the CE should notify the claimant as to why the benefit cannot be granted. The prescribing physician and the physical therapy provider should be copied with this letter. This letter should not contain appeal rights.
2. Any request by the claimant for a formal decision on the denial of the additional physical therapy should be granted. (PM 2-1400.2a.(2)).
3. No pre-termination notice is required if the claimant was notified of the specific authorized period, i.e. 120 days from the DOI, date of recurrence or date of surgery, and any specified period of extension, and physical therapy is not paid for any period other than that actually authorized in writing. In this circumstance, OWCP has not led the claimant to expect that payment for the service will continue.
Alternative Approaches to Supervised Physical Therapy
1. Often physical therapists can instruct patients in home exercise programs or other types of self-directed exercise to achieve or preserve the functional goals of the physical therapy program. When presented with a request for additional physical therapy, the CE should explore whether the claimant is ready to transition to a self-directed home or gym exercise program.
2. In reaching this determination, the CE should carefully consider the efficacy of past supervised therapy and the magnitude of any expected functional improvement.
3. Developmental requirements for health facility membership and special equipment can be found in PM 2-810-15. The DFEC Letter Generation System contains development letters for health facility membership and in-home therapy equipment. (See CA-6042, CA-6043 and CA-6044.)
Chiropractic and Osteopathic Manipulative Treatment
1. If a spinal subluxation has been accepted, manual manipulation of the spine by a chiropractor is payable. However, other physical therapy services, even if performed by a chiropractor, are subject to the requirements described above.
2. When the treating physician prescribes manipulative treatment by a chiropractor or an osteopathic physician, this therapy is subject to the above procedures.
3. Physical therapy services provided by a chiropractor or osteopath must be recommended and directed by the treating physician.
Changes to the Federal Employees' Compensation System (FECS)
1. A new edit code, 380L, has been added to the Bill Processing System (BPS).
b. This limits payment of CPT-4 code 97001 (initial physical therapy evaluation) to one time per year.
c. This edit is set to deny without the possibility of override.
d. The Explanation of Benefits description is as follows: INITIAL PHYSICAL THERAPY EVALUATIONS ARE LIMITED TO ONE PER YEAR. THIS SERVICE HAS BEEN PROVIDED IN THE LAST 365 DAYS. FOR FURTHER CONSIDERATION, RESUBMIT BILL WITH MEDICAL JUSTIFICATION AND A COPY OF THIS NOTICE.
2. Some additional physical therapy edits will be added to the BPS early in 2002.
b. The BPS will limit payment of manual manipulation services to "R" type providers.
c. If no subluxation medical condition has been accepted, manual manipulation services furnished by an "R" type provider will pay only if prior authorization has been entered in screen #34, PHYSICAL THERAPY AUTH of the CMF.
d. All physical therapy services, other than manual manipulation services, furnished by an "R" type provider will pay only for periods of prior authorization entered in screen #34, PHYSICAL THERAPY AUTH of the CMF.
CE Review of High Cost Physical Therapy Cases
1. On approximately the tenth of every month, each district office will be provided with a Physical Therapy High Cost Cases Report for their office.
2. The list will include cases in which the physical therapy costs over the past 12 months are in the top 1% of physical therapy costs nationally and in which payment for a physical therapy treatment has been made within the last 90 days.
3. The report will list the responsible CE, case number, claimant's name, total physical therapy costs paid under this claim number during the last 12 months, CPT code(s) from the last payment made, provider type of the last provider paid, EIN and address of the last provider paid. (See Attachment 1.)
4. The responsible CE (or designated person) should carefully review the case file and ensure that the therapy being provided is appropriate and necessary. At the time of the initial review of each claim appearing on the high cost report, an Initial Evaluation Report must be completed and returned to the National Office coordinator for compilation and analysis of statistics. This should be accomplished electronically. Only one initial evaluation report is required per case. (See Attachment 2.)
5. If the case record does not support the need or benefit of continued therapy, the CE should utilize the PT High Cost Letter to query the prescribing physician on the effectiveness of the current program and on alternatives to supervised therapy. This is a new letter that has been added to the DFEC Letter Generation System under Miscellaneous/Physical Therapy.
6. Use of a second opinion evaluation is encouraged in these cases in order to independently confirm the need for continued therapy.
7. The responsible CE (or designated person) will be responsible for completing a Final Disposition Report at the point the physical therapy issue has been resolved. This report should be returned to the National Office coordinator for compilation and analysis of statistics. This should be accomplished electronically. If no development is being undertaken and the reason is described on the Initial Evaluation Report, a Final Disposition report is not required. (See Attachment 3.)
Disposition: Retain until the indicated expiration date.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 1 – Folioviews Groups A and D (Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists and Staff Nurses)
|
RCE |
Case Number |
Last Name |
First Name |
Total PT |
Last PT |
CPT Codes |
Provider Type |
EIN Name |
|---|---|---|---|---|---|---|---|---|
Back to Top of FECA Bulletin No. 02-03
|
___________________ |
__________________ |
INITIAL EVALUATION REPORT OF HIGH COST PT CASES
1) Is the case being excluded from development because a subluxation has been accepted and the attending physician is a chiropractor and the only therapy procedures being paid are either manual manipulation (CPT-4 codes 98940-98943) or office visits (CPT-4 codes 99201-99215)?
Yes _____________
2) Is the case being excluded from development because the accepted condition(s) is a severe brain or spinal cord injury, extensive second or third degree burns or other severe injury that has rendered the claimant bedridden permanently or for an extended period of time?
Specify condition(s): ____________________________________________________________
3) Is the case being excluded from development because the claimant received PT services only during the initial approval period of 120 days from:
Date of injury - Traumatic: __________________
OD: _______________
Date of authorized surgery (show date): _________________
Date of accepted recurrence (show date): ________________
4) Show all condition(s) for which physical therapy is being administered (based on evidence of record): ______________________________________________________________
5) Does the claimant have a pre-existing, non-work related medical condition?
Specify condition(s):
____________________________________________________________
6) Describe PT development initiated in this case.
Release of PT High Cost Letter (date released): ___________
Referral for SECOP/IME (date referred): ___________________
Other explain): ___________________________________________
7) If no PT development is being initiated for a reason other than those listed above, please provide an explanation of why development is not required.
____________________________________________________________
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FINAL DISPOSITION REPORT OF HIGH COST PT CASES
1) The attending physician determined no further physical therapy was required.
(Provide date PT stopped.) ______________________________
2) Physical therapy authorization was terminated as the medical evidence of record failed to support a continuing need.
Informal denial letter sent. (Show date.): _______________
Formal decision issued. (Show date.): ____________________
3) Physical therapy was terminated as a result of SECOP/IME. (Provide date of formal decision.)
_____________________
4) Some form of self-directed therapy was authorized in lieu of on-going directed therapies. Describe the form of self-directed therapy authorized, i.e. home equipment or fitness center membership. (Include type of equipment authorized.)
__________________________________________________________
______________________________________________________________
5) All compensation and/or medical care was terminated as the evidence of record supported no continuing residuals of the accepted condition. (Show date of formal decision.)
_______________________________
6) Other. Provide explanation. ______________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
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FECA BULLETIN NO. 02-04
Issue Date: January 14, 2002
Expiration Date: January 2003
Subject: Revised procedures for processing work-related injury claims filed by employees of the Office of Workers' Compensation Programs and their relatives in the Midwest (formerly Chicago) Region.
Background: Current procedures for Mail and File require that all cases filed by employees of the Office of Workers' Compensation Programs and their relatives are under the jurisdiction of the Kansas City district office for adjudication and case management. The Kansas City district office is now assigned to the Midwest Region. The Midwest Region now includes Illinois, Indiana, Michigan, Minnesota, Wisconsin, Ohio, Iowa, Kansas, Missouri, and Nebraska. Therefore, procedures for adjudicating and maintaining injury compensation claims involving employees of the Office of Workers' Compensation Programs and their relatives must be revised. OWCP claims outside the Midwest Region will continue to be processed in the Kansas City district office (except Job Corps).
Reference: Federal (FECA) Procedure Manual, Chapter 1-200-2(g)2 and Chapter 1-200-2(l).
Purpose: To transfer jurisdiction for all claims filed by employees of the OWCP and their relatives originating in the Midwest Region (Illinois, Indiana, Michigan, Minnesota, Wisconsin, and Ohio) from the Kansas City district office (District 11) to the National Operations Office (District 25).
Applicability: Regional Directors, District Directors, Claims Examiners, Supervisory Claims Examiners, Mailroom Supervisors, and appropriate National Office personnel.
Action:
1. Effective immediately, all claims for work-related injuries filed by OWCP employees and their relatives in the Midwest Region are under the jurisdiction of and should be filed in the National Operations Office (District 25).
2. The Kansas City district office (District 11) will forward all existing case files, that involve OWCP employees and their relatives living and/or working in the Midwest Region to the National Operations Office (District 25) for maintenance and handling.
Disposition: This Bulletin should be retained until incorporated into the Federal (FECA) Procedure Manual, or otherwise superseded.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 1--Folioviews Groups A,B,C,D (Regional Directors, District Directors, Claims Examiners, All Supervisors, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)
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FECA BULLETIN NO. 02-05
Issue Date: January 14, 2002
Expiration Date: January 31, 2003
Subject: Comp Pay/ACPS – Employing Agency Action to Notify DFEC of Claimant Ineligibility for Continuing Life Insurance.
Purpose: To furnish instructions on new Office of Personnel Management (OPM) guidance to employing agencies regarding determinations of continuing eligibility for life insurance.
Applicability: Appropriate National Office and District Office personnel.
Reference: FECA PM Part 5, Chapter 5-400(11)(a). OPM Procedures are detailed in OPM BAL Number 01-216 dated August 21, 2001.
Background: Agencies ordinarily notify DFEC of what type(s) of life insurance the employee has by means of a CA-7 (Claim for Compensation On Account of Traumatic Injury or Occupational Disease); DFEC withholds the FEGLI premiums accordingly from the individual's compensation. Employees who are receiving workers' compensation benefit payments may continue their Federal Employees' Group Life Insurance (FEGLI) coverage if they meet OPM's Five-Year/All-Opportunity requirement as of the date they start receiving compensation. Claimants that do not meet OPM's Five-Year/All-Opportunity requirement are still entitled to remain insured as an employee for up to 12 months in a non-pay status, or separation from federal service, whichever comes first. At that point the employing agency must make an eligibility determination and notify DFEC accordingly. It is the responsibility of the employing agency to notify both OPM and DFEC of any change in the claimant's entitlement to FEGLI coverage.
Action: For those claimants where it is clear that they will not meet OPM's Five-Year/All-Opportunity requirement, the employing agency must notify DFEC. This notification is necessary to ensure that optional life insurance withholdings can be appropriately stopped at the end of 12 months in non-pay status (or separation, if that happens first). In order to notify DFEC, the agency must complete a Notice of Life Insurance Ineligibility (copy attached). This form will be sent to the district office at the same time the Form CA-7 is submitted.
In addition to sending the Notice of Life Insurance Ineligibility to DFEC, a copy will be sent to the claimant. This will notify the claimant that the FEGLI coverage will terminate upon separation or completion of 12 months in non-pay, whichever comes first. The claimant will also be notified that they have the right to convert the coverage upon termination of FEGLI coverage.
The claims examiner will place a call-up in the system to indicate that life insurance premiums must be stopped at the end of 12 months of non-pay or separation.
Disposition: This Bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until further notice or the indicated expiration date.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 2 --Folioviews Groups A and D (Claims Examiners, AllSupervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, and Rehabilitation Specialists)
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FECA BULLETIN NO. 02-06
Issue Date: January 31, 2002
Expiration Date: January 31, 2003
Subject: Compensation Pay: Compensation Rate Changes Effective January 2002
Background: In December 2001, the President signed an Executive Order implementing a salary increase of 3.60 percent in the basic pay for the General Schedule. The applicability under 5 U.S.C. 8112 only includes the 3.60 percent increase in the basic General Schedule. Any additional increase for locality-based pay is excluded. The adjustment is effective the first pay period after January 1, 2002.
Purpose: To inform the appropriate personnel of the increased minimum/maximum compensation rates, and the adjustment procedures for affected cases on the periodic disability and death payrolls.
The new rates will be effective with the first compensation payroll period beginning on or after January 1, 2002. The new maximum compensation rate payable is based on the scheduled salary of a GS-15, Step 10, which is now $107,357 per annum. The basis for the minimum compensation rates is the salary of $16,592 per annum (GS-2, Step 1).
The minimum increase specified in this Bulletin is applicable to Postal employees.
The effect on 5 U.S.C. 8112 is as follows:
|
Effective January 2, 2002 |
Minimum |
Maximum |
|---|---|---|
|
Monthly |
$1,037.00 |
$6,709.81 |
The effect on 5 U.S.C. 8133(e) is to increase the minimum monthly pay on which compensation for death is computed to $1,037.00, effective January 2, 2002. The maximum monthly compensation as provided by 5 U.S.C. 8133(e)(2) is increased to $6,709.81 per month.
Applicability: Appropriate National and District Office personnel
Reference: Memorandum for Directors of Personnel dated December 2001; and the attachment for the 2002 General Schedule.
Action: ACPS will update the periodic disability and death payrolls. Any cases with gross overrides will not have a supplemental record created. Thus, the cases with gross overrides must be reviewed to determine if adjustments are necessary. If adjustment is necessary, a manual calculation will be required.
1. Adjustments Dates.
a. As the effective date of the adjustment is January27, 2002, there will be no supplemental payroll necessary for the periodic disability and death payrolls.
b. The new minimum/maximum compensation rates will be available in ACPS on or about January 21, 2002.
2. Adjustment of Daily Roll Payments. Since the salary adjustments are not retroactive, it is assumed that all Federal agencies will have ample time to receive and report the new pay rates on claims for compensation filed on or after January 1, 2002. Therefore, it will not be necessary to review any daily roll payments unless an inquiry is received. If an inquiry is received, verification of the pay rate must be secured from the employing establishment.
3. Minimum and Maximum Adjustment Listings. Form CA-842, Minimum Compensation Pay Rates, and Form CA-843, Maximum Compensation Rates, should be annotated with the new rate information as follows:
|
CA-842 – 01/02/02 |
||||
|
47.86-71.79 |
239.31-358.96 |
47.86 |
239.31(959.24) |
1,037.00 |
|
CA-843 – 01/02/02 |
||||
|
309.68 |
|
1,548.42(6,193.68) |
6,709.81 |
|
4. Forms. CP-150, Minimum/Maximum Compensation, will be generated for each case adjusted. It should be noted that this adjustment process re-calculates EVERY ACPS record from very beginning to current date, thus, it may be that minor changes in the gross compensation are noted; this is not necessarily incorrect. Notices to all payees receiving periodic compensation payments will be generated, informing them of potential changes to their compensation benefits.
The notices will be sent as an attachment to the Benefit Statement generated after each periodic cycle. Manual adjustments necessary because of gross overrides should be made on Forms CA-24 or CA-25 with a notice sent to the payee by the District Office.
Disposition: This bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until the indicated expiration date.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 2--Folioviews Groups A and D (Claims Examiners, All Supervisors, Systems Managers, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal and Bill Pay Personnel)
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FECA BULLETIN NO. 02-07
Issue Date: March 1, 2002
Expiration Date: February 28, 2003
Subject: Comp Pay/ACPS - Consumer Price Index (CPI) Cost-of-Living Adjustments for March 1, 2002.
Purpose: To furnish instructions for implementing the CPI adjustments of March 1, 2002.
1. The new CPI increase, adjusted to the nearest one-tenth of one percent, is 1.3 percent.
2. The increase is effective March 1, 2002, and is applicable where disability or death occurred before March 1, 2001.
3. The new base month is December 2001.
4. The maximum compensation rates, which must not be exceeded, are the following:
| Amount | Time |
|---|---|
|
$ 6,797.04 |
per month |
Applicability: Appropriate National Office and District Office personnel.
Reference: FECA Consumer Price Index (CPI) Amendment, dated January 6, 1981.
Action: On or about March 14, 2002, both the periodic disability and death payrolls will be updated in ACPS. If there are any cases with gross overrides, there will be no supplemental record created. Thus, the cases with gross overrides must be reviewed to determine if CPI adjustments are necessary. If adjustment is necessary, a manual calculation will be required.
1. Adjustment Dates.
a. As the effective date of the CPI is March 1, 2002 and the start date of the periodic and death payroll cycles is February 24, 2002, there will be a supplemental record created for the period March 1 through March 23, 2002. Effective March 24, 2002, the periodic and death payrolls will reflect the increased amount.
b. The CA-816, LWEC, program will be updated with the new CPI percentage. This update will be performed for all district offices by the National Office.
2. Adjustments of Daily Roll Payments. Since the CPI will not be in ACPS until March 17, 2002, daily roll payment cases requiring the new CPI should be held for data entry until that date. ACPS RECORDS THAT REQUIRE ADJUSTMENT SHOULD NOT BE ENTERED BETWEEN MARCH 14, 2002 AND MARCH 17, 2002. ACPS data entry may resume on March 18, 2002.
3. CPI, Minimum and Maximum Adjustments Listings. Form CA-841, Cost-of-Living Adjustments; Form CA-842, Minimum Compensation Rates; and Form CA-843, Maximum Compensation Rates, should be updated with the new information. Attached to this directive is a complete list of all the CPI increases and effective dates since October 1, 1966 through March 1, 2002.
4. Forms.
a. Beginning with the compensation payment cycle that covers March 24, 2002 to April 20, 2002, the Office will issue an updated monthly Benefit Statement to each individual receiving benefits on the 28-day periodic roll cycle. This Benefit Statement will state the gross amount of compensation, the period of compensation covered by the statement, and the pertinent deductions made from the gross compensation. For compensation payments made via paper checks, the Benefit Statement will accompany the check. For compensation payments made through Electronic Fund Transfer (EFT), the Benefit Statement will be mailed separately.
b. Any manual adjustments necessary because of gross overrides in cases should be made on Form CA-24 or CA-25. A notice to the payee should be sent from the district office.
c. A CP-140 report will be printed for each case adjusted, upon specific request by a District Office.
d. If claimants write or call for verification of the amount of compensation paid (possibly for mortgage verification; insurance verification; loan application; etc.), please provide this data in letter form from the district office. Many times a benefit statement may not reach the addressee, and regeneration of the form is not possible. Thus, a simple letter indicating the amount of compensation paid every four weeks will be an adequate substitute for this purpose.
Disposition: This Bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until further notice or the indicated expiration date.
DEBORAH B. SANFORD
Director, Federal Employees' Compensation
Distribution: List No. 2 --Folioviews Groups A and D (Claims Examiners, All Supervisors, District Medical Advisors, Fiscal Personnel, Systems Managers, Technical Assistants, and Rehabilitation Specialists)
Attachment
|
EFFECTIVE DATE |
RATE |
EFFECTIVE DATE |
RATE |
|---|---|---|---|
|
10/01/66 |
12.5% |
03/01/81 |
3.6% |
Prior to 09/07/74, the new compensation after adding the CPI is rounded to the nearest $1.00 on a monthly basis or the nearest multiple of $.23 on a weekly basis ($.23, $.46, $.69, or $.92). After 09/07/74, the new compensation after adding the CPI is rounded to the nearest $1.00 on a "periodic" basis or the nearest $.25 on a weekly basis ($.25, $.50, $.75, or $1.00).11
| Date | Rate | Date | Rate |
|---|---|---|---|
|
Prior to 11/1/74 |
.08-.34 = .23 |
Eff. 11/01/74 |
.13-.37 = .25 |
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FECA BULLETIN NO. 02-08
Issue Date: February 5, 2002
Expiration Date: February 5, 2003
Subject: BPS -Revision in the Reimbursement Rates Payable for the Use of Privately Owned Automobiles(POV) Necessary to Secure Medical Examination and Treatment.
Background: Effective January 21, 2002, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobile has increased to 36.5 cents per mile by GSA. No restriction is made as to the number of miles that can be traveled. As in the past, this rate will also apply to individuals covered by the FECA who travel by POV in order to obtain necessary medical examination and treatment.
Applicability: Appropriate National Office and District Office personnel.
Reference: Chapter 5-0204, Principles of Bill Adjudication, Part5, Benefit Payments, Federal (FECA) Procedure Manual; Instruction CA-77, Instructions for Submitting Travel Vouchers; and 5 USC 8103.
Action: Instruction CA-77, Instructions for Submitting Travel Vouchers, has been revised to reflect the indicated rate change. A copy of the revised instructions is attached to this bulletin and may be reproduced at local levels. Vouchers being processed for travel periods after January 21, 2002 may be adjusted to reflect this increase.
Disposition: This Bulletin should be retained in Chapter 5-0204, Principles of Bill Adjudication, Federal (FECA) Procedure Manual.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 2 -- Folioviews Groups A and D (Claims Examiners, All Supervisors, Systems Managers, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal/Bill Pay Personnel)
Attachment 2
Instructions for Submitting Travel Vouchers U.S. Department of Labor (For reimbursement of travel and related expenses Employment Standards Administration under the Federal Employees' Compensation Act) Office of Workers' Compensation Programs
---------------------------------------------------------------------------------------------------------------------------------
Note: Any item not in conformity with the following instructions and not legible will be deducted from the voucher. Both forms SF-1012 and SF-1012a MUST be submitted with a valid case file number.
1. Claim for necessary and reasonable expense incident to travel authorized in accordance with provisions of the Federal Employees Compensation Act may be submitted for consideration on Voucher Forms SF-1012 and SF-1012a. Travel must be by shortest route and, if practicable, by public conveyance (streetcar, bus, boat, or train).
2. The Office will promptly reimburse all bills received on the approved form and submitted in a timely manner. However, no bill will be paid for expenses incurred if the bill is submitted more than one year beyond the calendar year in which the expense was incurred or the service or supply was provided, or more than one year beyond the calendar year in which the claim was first accepted as compensable by the Office, whichever is later (per CFR §10.413).
3. Payment will be made for taxicab fare or the hire of special conveyance where streetcars, buses, or other public and regular means of transportation are not available, except where these cannot be used because of the injured employee's disability. If claim is made for payment of expenses for taxicabs or hire of special conveyances, a full explanation must be made showing the necessity thereof.
4. Reimbursement for transportation by automobile owned by an employee or a member of his/her immediate family or another Government employee, may be claimed when no public conveyance is available or where the physical condition of the injured employee requires the use of special conveyance.
Mileage expenses will be reimbursed at the following rates for travel during the following periods:
| Dates | Amount |
|---|---|
|
January 1, 1995 to June 6, 1996 |
30.0 cents per mile |
If mileage expense is claimed prior to January 1, 1995, contact your OWCP district office for rates.
5. Claim may be made for parking fees. If travel must be over a toll route, toll charges may be claimed. The voucher must show the locations where travel began and ended, mode of travel, and name of the transportation company (if by public conveyance). List each item of expense separately, showing the date incurred, place, and cost of the travel.
6. There will be no reimbursement for meals or lodging when travel is for less than 12 hours in total. If the authorized travel was for longer than 12 hours, and a claim for meals or lodging is made, the dates and hours must be shown on the voucher. The necessity for lodging must be explained in detail. All charges must be reasonable, and will be reimbursed at the per diem rate for the locality of travel.
7. Any stopover or delay en route should be carefully explained. If several trips are covered by the same voucher, list each separately, indicate the purpose of each trip, and secure the approval of the attending physician, certifying that the dates are correct according to his/her records.
8. Original itemized receipts made out in factor of the person making payment, signed in ink or indelible pencil by the person receiving payment must be furnished for all items in excess of $75.00.
9. After a voucher SF-1012 has been completed, it must be signed in ink or indelible pencil in the space provided for the payee.
10. The travel voucher should not be submitted if there is no expense claimed.
INSTRUCTION CA-77
Revised January 2002
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FECA BULLETIN NO. 02-10
Issue Date: June 14, 2002
Expiration Date: June 14, 2003
Subject: Bill Payment-Physical Therapy Multiple Initial Evaluations
Background: Edit code 380L was added to the Bill Processing System (BPS) to limit payment of CPT-4 code 97001 (initial physical therapy evaluation) to one time per year. This edit is set to automatically deny without the possibility of override. The Explanation of Benefits advises that the medical provider can resubmit the bill with medical justification for further consideration of payment (see FECA Bulletin 02-03). Medical providers are now presenting valid reasons for the use of the 97001 code more than one time per year. Since CPT-4 Code 97001 is allowed payment only one (1) time a year this inhibits the payment of medical providers following further consideration. The use of another code prevents the application of the fee schedule and duplicate edits. Additionally, there is no established system for monitoring these transactions.
A new OWCP Program-Specific Code has been developed to assist district offices in making payment in those cases that are medically justified for more than one initial physical therapy evaluation in a year.
Reference: FECA Procedure Manual Chapter 2-810-16, FECA Bulletin NO. 02-03 and FECA Procedure Manual Part 5.
Purpose: To notify district offices of the OWCP Program-Specific Code used only in cases in which more than one (1) initial physical therapy evaluation is medically justified within a year.
Applicability: Claims Examiners, All Supervisors, System Managers, District Medical Advisors, Mail and File Personnel, Fiscal and Bill Pay Personnel, Staff Nurses, Technical Assistants, Hearing Representatives and Hearing Examiners.
Action:
1. A new OWCP Program-Specific Code, PT2IE, (physical therapy second initial evaluation) payment for multiple PT Initial Evaluations has been added to the Procedure File (V30) in all district offices.
2. All provider requests for further consideration for the use of 97001 should be referred to the district office's medical coding specialist or other designated staff member (Assistant District Director, fiscal or bill processing personnel, FECA PM Part 5).
3. The medical coding specialist or other staff member will assess the validity of the request. Situations that require a second initial physical therapy evaluation within a one (1) year timeframe include: a newly accepted consequential injury, surgery, and claimant referral to another health provider for evaluation.
4. Should the service be considered payable, the reviewer will re-process the bill. The reviewer will use PT2IE instead of the original 97001. There will be limited use of this code. The designated reviewer will provide instruction in the notes that the bill is approved for payment processing.
5. If the service is not deemed payable, the reviewer should notify the provider that the service is not payable by the program.
6. Training should be done by an appropriate staff member within thirty (30) days. This item will be viewed as part of the physical therapy standards and will be subjected to case review in upcoming Accountability Reviews.
Disposition: Retain until the indicated expiration date.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List NO.2-Folioviews Group A,B and C (Claims Examiners (including Seniors), All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants,Rehabilitation Specialists, Staff Nurses, Fiscal and Bill Pay Personnel)
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FECA BULLETIN NO. 01-01
Issue Date: October 25, 2000
Expiration Date: October 24, 2001
Subject: Bill Payment/BPS - "Real-Time" Pharmacy
Background: Since the summer of 1998, DFEC has been receiving and processing bills received via electronic data interchange (EDI). Since that time, the proportion of direct pharmacy billing has increased, and approximately 50 percent of all pharmacy bills are now received via EDI.
A new service is being offered to pharmacies effective October 23, 2000. "Real-time" pharmacy bill processing will allow pharmacies, through a clearinghouse intermediary, to enter information concerning a pharmacy bill on their point of sale device and receive a rapid response from OWCP as to whether the bill is payable, and the amount payable. If the bill is payable, the claim will be captured and processed by OWCP.
Reference: FECA Bulletin 98-11.
Purpose: To notify District Offices of an enhancement to the bill processing system.
Applicability: All staff.
Actions:
1. DFEC will receive and process "real-time" electronic bills from pharmacies for prescription drugs, through intermediary clearinghouses. Through a secure communications link, pharmacies will be able to submit bills to a central location in the National Office. The bills will undergo editing that essentially mirrors the editing performed by the bill edit program (BILL552), and the pharmacy will receive an immediate (on-line) response as to the payability of the bill.
2. If the bill is determined to be payable, the amount payable under the fee schedule will be calculated, and the pharmacy (through the clearinghouse) will receive a message that the bill is approved, and the amount payable.
3. If the bill is not payable, the pharmacy (through the clearinghouse) will receive a message that the bill is not payable, and the reason. After that, the pharmacy may submit the bill to OWCP through the regular EDI process, or submit the bill in paper form for routine processing by the district office.
4. The payable bills will be transmitted to the appropriate district office for processing. "Real-time" bills will be loaded automatically via BILL516.
5. A batch number assignment scheme similar to that devised for EDI pharmacy bills has been developed for "real-time" pharmacy bills, as follows:
The first three characters will be EDR
The fourth character is a letter from A to L, which
represents month 01-12.
The fifth character is a letter from A to Z, or number
between 1 and 5, which represents the day of the month.
The sixth character is a letter between A and Z which
represents the number of batches between 01 and 26.
6. The "real-time" bills will be loaded with a bill total equal to the sum of the payable amounts for each line item. The line item amount will be the actual amount billed by the pharmacy. If the payable amount for the line (due to the application of the fee schedule) is less than the billed amount, an ineligible amount equal to the difference between the two will be loaded, with an ineligible amount code of I. If the payable amount equals or exceeds the billed amount, these two fields will be blank.
7. All "real-time" bills will be loaded with an appeal code of B, so that the fee schedule is bypassed. Reapplication of the fee schedule is not needed, since it will have been applied already during National Office processing.
8. Once the EDR bills are loaded into the bill tables on the Sequent, they will be edited by a modified version of the bill edit program, which applies only duplicate (edits 801-805) and restricted/excluded provider (edits 201, 202) edits. No new edits are required for "real-time" bills.
9. BILL552 reports will be produced for the EDR batches (along with other bills). The number of suspended "real-time" bills should be minimal. Any bills that do suspend will require resolution, in accordance with existing procedures.
10. As with the EDI pharmacy bills, because the "real-time" bills are submitted electronically, ability to change the data in bill resolution is very limited. The only data field which may be accessed in bill resolution is the bypass code.
11. As with EDI pharmacy bills, the addresses for "real-time" pharmacy bills are obtained from a central location, rather than the district office provider file. The address sequence number will be FD, and claimant reimbursements will not be allowed.
Disposition: Retain until incorporated in the Federal (FECA) Procedure Manual.
DEBORAH B. SANFORD
Acting Director for
Federal Employees' Compensation
Distribution: List No. 3--Folioviews Groups A, B, C, and D
(All FECA Employees)
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FECA BULLETIN NO. 01-02
Issue Date: November 15, 2000
Expiration Date: November 14, 2001
Subject: Bill Payment/BPS - Modifications to Inpatient Hospital Bill Procedures
Background: A fee schedule for inpatient hospital bills, based on the Medicare system of Diagnosis-Related Groups (DRGs), was implemented January 4, 1999. Since then, inpatient hospital bills have been data entered using special software on a stand-alone computer. Bills processed as inpatient bills have been limited to those containing certain codes in the Locator-4 position on the UB-92 billing form.
Through processing inpatient hospital bills, we have found that there are various categories of inpatient bills that could not be processed accurately through the existing mechanism and/or required extensive manual handling by District Office staff. These categories include interim bills, bills from intermediate care units within hospitals (skilled nursing facilities), and short stay (1 day) bills.
In addition, because of the unique characteristics of bills processed under FECA, and the relatively small number of such bills when compared to the Medicare system, adjustments are being made to the payment calculation algorithms. The maximum amount payable for any inpatient bill will be limited to no more than 120% of the billed amount. Allowable charges for stays of less than 24 hours will be calculated based on the applicable cost-to-charge ratio for the state in which the hospitalization took place.
Allowable fees for the new categories of bills (interim and skilled nursing facility bills) will also be processed using a cost-to-charge ratio.
The above changes will be applicable to all inpatient bills regardless of dates of service. However, it should be noted that the pricing factors are updated annually by the Health Care Financing Administration (HCFA) effective October 1 of each year. The date of discharge is used to determine which year's pricing factors are applied to a particular bill, and only five year's worth of pricing data is maintained.
Reference: FECA Bulletins 99-21 and 99-31; Federal (FECA) Procedure Manual, Chapter 5-203, Exhibit 1.
Purpose: To notify District Offices of revised procedures for processing inpatient hospital bills.
Applicability: All staff.
Actions:
1. Effective November 15, 2000, the parameters for separating inpatient from outpatient bills are as follows:
a. The first digit of the code in form locator 4 must be 1, 2, 4, 6, or 8; the second digit 1, 2, 5, 6, 7 or 8; and the third digit 1, 2, 3, 4 or 7; and
b. Room and board charges are present on the bill. Such charges are shown with RCCs of 100 through 169.
2. Hospital bills meeting the above guidelines will be forwarded to the National Office in accordance with FECA Bulletin 99-31 for data entry.
3. The FECS001 "Bill Input" program has been modified to block data entry of the additional inpatient hospital locator 4 codes, as described above.
4. If a hospital appeals fee reductions on interim bills, the allowable fee for the entire hospitalization may be recalculated once the patient is discharged, and the admit through discharge bill is provided. The total sum of the previously paid amounts should be shown as a prior paid amount in Locator-54 on the UB-92 form.
Training on these procedures should be completed as soon as possible.
Disposition: Retain until incorporated in the Federal (FECA) Procedure Manual.
DEBORAH B. SANFORD
Acting Director for
Federal Employees' Compensation
Distribution: List No. 3--Folioviews Groups A, B, C, and D
(All FECA Employees)
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FECA BULLETIN NO. 01-03
Issue Date: December 26, 2000
Expiration Date: December 25, 2001
Subject: Bill Payment/BPS – Prior Authorization for Pharmacy
Background: Currently DFEC receives and processes pharmacy bills via electronic data interchange (EDI) and in paper form for routine processing by the district office. Recently, "Real-Time" processing was implemented (see FECA bulletin 01-01) as a service to pharmacies that allows them to know immediately if a medication is payable. This service will result in an increase in EDI bills since many pharmacies would not use the previous batch process without assurance of payment. Because "Real-Time" pharmacy bills are edited at a central location, bills that formerly would have suspended at the district office are now rejected in the "Real-Time" process. In order to allow offices to record their decisions on these bills, so that a greater proportion of pharmacy bills in both the "Real-Time" and other processes may be processed without suspension or rejection, a prior authorization function for pharmacy has been developed. The new desktop application will allow Claims Examiners to authorize or deny a particular drug. An authorization takes precedence over therapeutic class to ICD-9 relationship editing. A pharmacy bill that currently suspends with error 738 requires manual review; prior authorization will prevent bill suspensions.
New edits have been developed to assist with the processing of pharmacy bills where a prior authorization exists. A new table has been created to capture pharmacy prior authorization decisions. The new prior authorization function will be available for use on or after December 26.
Reference: FECA Bulletins 01–01, 99–04, and 98–11.
Purpose: To notify District Offices of the new prior authorization process for prescription drugs.
Applicability: All staff.
Actions:
1. DFEC will continue to receive and process "Real-Time" bills from pharmacies for prescription drugs through intermediary clearinghouses.
2. If a "Real-Time" bill is submitted and the therapeutic class to ICD-9 relationship editing results in a suspend decision, and no authorization is found for the therapeutic class on the new table, normal relationship editing will occur resulting in a rejection. The pharmacy will receive the message, "Needs manual review". In cases where the general suspense flag is set to "Y" the pharmacy will receive the message, "All bills require manual review." When either of the previous situations occur, the pharmacy may contact the district office for authorization. The CE must enter a decision to either pay or deny the medication. The authorization will take effect immediately at the central site. Once the decision is entered, the pharmacy can resubmit the bill right away.
3. The prior authorization function may also be used for pharmacy bills submitted through the EDI batch process or on paper. The authorization function will most commonly be used when a bill suspends with edit 738, if an EOB return is received for edit 734, or as the result of a telephone request for authorization.
4. To authorize payment for a medical condition, the CE will first double-click on the desktop application icon, and enter the Sequent user ID and password. The CE will then enter the case and NDC numbers into the authorization screen and select "Submit Query" (see Attachment 1). The results of the query are a complete list of existing authorizations, therapeutic class, action, add date, change date, and begin and end dates. From this screen, the CE may also view case notes, accepted conditions, NDC information, therapeutic class description and therapeutic class to IDC-9 relationships ( see Attachments 2a, see Attachments2b-c , see Attachment 3). Other pertinent information provided is the case type, status, and date of injury.
5. The CE should review the accepted condition list, which also includes modifiers, e.g., aggravation, right, left, or both. In addition, the therapeutic class descriptions and ICD-9 relationships should also be reviewed. Note that if the case contains ICD-9 accepted conditions, only the therapeutic class to ICD-9 relationships for those conditions are displayed. If the case record contains no ICD-9 accepted conditions, then all of the therapeutic class to ICD-9 relationships for that therapeutic class are shown. If necessary, the CE may consult the case file record or reference materials (such as the Physicians' Desk Reference), or seek medical guidance.
6. If the CE decides to authorize a specific medication, click the "Add/Modify" icon located in the upper right corner of the authorization screen. A message, "Add a record for this Therapeutic Class?" will appear if no record for that class exists (see Attachment 4). If the user clicks on "Yes," then the add authorization screen will appear. The user must enter a decision (pay or deny) and enter the authorization period. The system decision defaults to pay, and the period defaults to today's date as the begin date, and one year from today's date as the end date. The default period of one year is considered a generous window that allows for the payment of drugs used in most cases. The user may authorize a shorter period whenever there is evidence that the medication will be used for only a limited time (i.e. antibiotics for a wound infection, muscle relaxants for a muscle sprain, etc.). Although the user can also authorize medications for periods longer than one year, this function should be used sparingly. Medications with high potential for addiction and abuse should not be approved for periods longer than one year, particularly, all opiate agonists, opiate partial agonists, and barbiturates. Once an authorization is entered, bills for medications in the same therapeutic class will pass the relationship edits until the date expires. After the CE enters a decision and authorization period, select "Save" to exit the add option.
7. The CE may also modify any existing authorizations. The CE should enter the case number, existing NDC code and click the "Add/Modify" icon located in the upper right corner of the authorization screen (see Attachment 5). The system default for the modify option is what is currently defined in the record. After selecting the record for modification, the modify authorization screen will appear. The CE can modify the record to "deny" if it was originally set to "pay" and vice versa, and modify the "begin" or "end" dates. After the CE modifies the record, select "Save" to exit the modify option. If no changes are made to the record, the change date field does not change.
8. The user may enter another authorization by selecting "New Query" or may "exit" the program through the file option located on the menu bar.
9. Two new Bill 552 edits (Attachments 6 and Attachments 7) have been developed for pharmacy prior authorization. Edit 335 is assigned when a therapeutic class has been denied for the date of service. Edit 336 is assigned when there is a matching authorization record (either pay or deny) for the therapeutic class, but the service dates are outside of the authorization dates.
10. An updated condensed edit list and EOB listing will be provided under separate cover.
11. Training on this Bulletin should take place as soon as possible. Offices must also be prepared to respond to telephone requests for authorization of prescription drugs.
Disposition: Retain until incorporated in the Federal (FECA) Procedure Manual.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 3–Folioviews Groups A, B, C, and D
(All FECA Employees)
Attachment 6 - Bill Edit 335L (Pharmacy Authorization)
|
December 1, 2000 |
|
|
|
MEDICAL BILL SYSTEM |
|
|
|
|
EDIT NO. 335L |
|
|
ERROR DESCRIPTION: |
THERAPEUTIC CLASS DENIED |
|
EDIT DESCRIPTION: |
PHARMACY AUTHORIZATION TABLE CONTAINS DENIAL FOR THE |
|
SUSPEND/DENY: |
D |
|
OVERRIDE: |
N |
|
EOB: |
Payment for this medication is denied. |
|
PRIORITY: |
2 |
|
BILL RESOLUTION: |
|
|
This edit fails when a pharmacy authorization record has been established to deny any drug in the therapeutic class. To pay for the drug, the matching authorization record must be changed or deleted |
|
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Attachment 7 - Bill 336L (Pharmacy Authorization)
|
December 1, 2000 |
|
|
|
MEDICAL BILL SYSTEM |
|
|
|
|
EDIT NO. 336L |
|
|
ERROR DESCRIPTION: |
SERVICE DATES INVALID FOR AUTHORIZATION DATE |
|
EDIT DESCRIPTION: |
PHARMACY AUTHORIZATION TABLE CONTAINS RECORD FOR THE THERAPEUTIC CLASS ASSOCIATED WITH NDC CODE; ONE OR BOTH DATES OF SERVICE ARE OUTSIDE AUTHORIZATION DATES |
|
SUSPEND/DENY: |
S |
|
OVERRIDE: |
N |
|
EOB: |
Payment for this medication is denied. |
|
PRIORITY: |
2 |
|
BILL RESOLUTION: |
|
|
1. This edit fails when a pharmacy authorization record has been established to pay or deny any drug in the therapeutic class, but one or both of the dates of service for the item being processed are outside of the specified authorization or denial range. 2. Check the service from and to dates. If keyed incorrectly, correct. If a correction is made, and the change puts the service dates wholly within the authorization or denial range, continue processing and recycle the bill. 3. If the authorization or denial dates need to be adjusted, revise the dates for the therapuetic class and recycle the bill. 4. If a previously authorized drug is not allowable for the dates of service, set to deny. 5. If a previously denied drug is still not payable, set to deny.
|
|
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FECA BULLETIN NO. 01-04
Issue Date: January 4, 2001
Expiration Date: January 3, 2002
Subject: Periodic Roll Management: Evidence of Earnings
Background: Existing procedures which require a request for authorization from the claimant to obtain earnings information from the Social Security Administration (SSA) every three years have proven to be ineffective and cumbersome. Reports received from SSA rarely reflect earnings. Additionally, once evidence of earnings has been received, actions by OWCP have been inconsistent.
The frequency of the request for the SSA release form is being changed from every three years to every year, to coincide with the mailing of the CA-1032 request for earnings and dependency information from the claimant. This Bulletin also describes actions to take subsequent to the release of the form, and when evidence of earnings is received.
Reference: Federal (FECA) Procedure Manual, Chapter 2-812, paragraphs 4 – 7, 9, and 10; Title 5 U.S.C., §§ 8106 and 8110; 20 CFR 10.525 - 10.529, 20 CFR 10.535 – 10.537.
Purpose: To focus attention on this issue as a means to improving FEC performance and fiscal accountability, and to introduce new procedures aimed at more efficient monitoring and more consistent follow-up action when earnings are discovered.
Applicability: Regional Directors, District Directors, Claims Examiners, Supervisory Claims Examiners, and appropriate National Office personnel.
Action:
1. Effective immediately, the CA-935 will be mailed to claimants on the periodic roll annually, rather than every three years. The district offices will revise their current CA-1032 plan to include the mailing of a CA-935 (with enclosure SSA-581) in the package for completion and return within 30 days of the mailing. (This requirement will also affect all claimants on the daily roll for one year or more.)
2. When the duly completed and signed CA-1032 package (including the signed SSA-581 form) is returned, it will be filed in the case record. The SSA-581 form is considered valid for requesting earnings information from the Social Security Administration (SSA) for 60 days following the date it is signed by the claimant. The CA-1036 will no longer be sent routinely every three years.
3. When information of any kind is received suggesting possible employment or earnings, OWCP will issue form letter CA-1036 accompanied by the signed SSA-581 authorization form to SSA. The current SSA-581 will authorize the SSA to release any earnings information contained in its records. If the SSA-581 in file is older than 60 days, the CE must immediately request that the claimant sign a new form to be sent with the CA-1036 letter to SSA. In cases with PS (Schedule Award) status or PW (Loss of Wage-earning Capacity) status, referral to SSA is not necessary. In such cases, a brief memo to file will be prepared, indicating that the earnings noted do not affect the claimant's entitlement to monetary compensation.
4. A second request must be made for completion and return of the CA-1032 package, including the CA-935 (with SSA-581 enclosure), if it is not received within 30 days. If the SSA-581 authorization form is not signed and returned after a second request is made, the case must be referred to the OIG for investigation.
Disposition: This Bulletin should be retained until incorporated into the Federal (FECA) Procedure Manual, or otherwise superseded.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 1--Folioviews Groups A and D
(Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)
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FECA BULLETIN NO. 01-05
Issue Date: January 29, 2001
Expiration Date: January 29, 2002
Subject: Impairment/Schedule Awards: Fifth Edition of the AMA Guides to the Evaluation of Permanent Impairment
Background: Last November, the American Medical Association once again revised its Guides to the Evaluation of Permanent Impairment. Copies of the new volume have been furnished to all district offices. Major changes found in the new version are described in the attachment.
Purpose: To provide information about the use of the fifth edition of the AMA Guides and changes found in the new version.
Applicability: Claims Examiners, Senior Claims Examiners, Hearing Representatives, All Supervisors, District Medical Directors and Advisers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses.
Action:
1. All Claims Examiners and Hearing Representatives should begin using the fifth edition of the AMA Guides effective February 1, 2001. As of that date, correspondence with treating physicians, consultants and second opinion specialists should reflect the use of the new edition, and form letters that refer to the AMA Guides will shortly be revised to reflect this change.
2. Awards calculated according to any previous edition should be evaluated according to the edition originally used. Any recalculations of previous awards which result from hearings, reconsideration or appeals should, however, be based on the fifth edition of the Guides effective February 1, 2001.
3. As with previous revisions to the AMA Guides, awards made prior to February 1, 2001 should not be recalculated merely because a new edition of the Guides is in use. A claimant who has received a schedule award calculated under a previous edition may later make a claim for an increased award, which should be calculated according to the fifth edition. Should the later calculation result in a percentage which is lower than the original award, the Claims Examiner or Hearing Representative should make the finding that the claimant has no more than the percentage of impairment originally awarded, and that therefore the Office has no basis for declaring an overpayment.
Disposition: Retain until the indicated expiration date.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 1
(Claims Examiners, All Supervisors, District Medical Advisers, Systems Managers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)
ATTACHMENT 05-01
AMA Guides to the Evaluation of Permanent Impairment,Fifth Edition
The fifth edition of the AMA Guides to the Evaluation of Permanent Impairment is significantly different from previous editions. First, this edition incorporates new scientific and medical principles and diagnostic procedures. Second, it specifies when and how different measurements of impairment should be used. Last, but not least, the Guides have adopted a more user-friendly format. Chapters have been reorganized, references are provided, and each chapter contains a summary detailing the proper tables to be used in determining particular impairments.
A number of specific changes that will affect the calculation of schedule awards for FECA claimants are detailed below:
1. Whereas the fourth edition had a chapter on musculoskeletal disorders, in the new edition different chapters are assigned to the upper and lower extremities. These chapters are substantially changed from previous editions.
2. Table 16, "Upper Extremity Impairment Due to Entrapment Neuropathy", (p. 57, fourth edition) has been deleted. Upper extremity impairment secondary to carpal tunnel syndrome and other entrapment neuropathies should be calculated using Section 16.5d, Entrapment/Compression Neuropathy, and Tables 16-10, 16-11 and 16-15. The fifth edition clearly states that "in compression neuropathies, additional impairment values are not given for decreased grip strength" (p. 494).
3. The section on complex regional pain syndromes (CRPS), reflex sympathetic dystrophy (CRPS I) and causalgia (CRPS II) (pp. 495-497) has been expanded to clearly define the objective diagnostic criteria for these disorders (Table 16-16) and to detail the method for determining any associated upper extremity impairment. It should be noted that Chapter 13, The Central and Peripheral Nervous System also contains criteria that can be used to determine impairment caused by reflex sympathetic dystrophy and causalgia (Section 13.8, p. 343). However, the impairment measurements obtained from this table are expressed only in terms of the whole person, and further, the table differentiates between the dominant and non-dominant side of the body. For these reasons, the preferred method for determining impairment secondary to all complex regional pain syndromes is that described on pages 495-497.
4. The criteria for diagnosing and rating weakness not due to other ratable conditions, and for using grip and pinch strength measurements, have been clarified in Section 16.8 (pp. 507-511). The AMA Guides now state that the loss of strength should be rated separately only if it is based on an unrelated cause or mechanism. "Otherwise, the impairment ratings based on objective anatomic findings take precedence. Decreased strength cannot be rated in the presence of decreased motion, painful conditions, deformities, or absence of parts that prevent effective application of maximal force in the region being evaluated" (p. 508). Moreover, it continues to say that "motor weakness associated with disorders of the peripheral nervous system and various degenerative neuromuscular conditions are evaluated according to Section 16.5 and Chapter 13." Clearly, grip and/or pinch strength should not be used to calculate upper extremity impairment caused by a compression neuropathy such as carpal tunnel syndrome.
4. Regarding the lower extremities, the fifth edition Guides specifies when different evaluation methods should be used and which methods can be used in combination (Table 17-2). For example, arthritis impairments obtained from Table 17-31 cannot be combined with impairment determinations based on gait derangement (Table 17-5), muscle atrophy (Table 17-6), muscle strength (Tables 17-7 and 17-8), or range of motion (Section 17.2f). Before finalizing any physical impairment calculation that requires the combination of evaluation factors, the District Medical Advisor or Director should verify the appropriateness of the combination in Table 17-2.
5. The chapter on impairments due to pain (Chapter 18) has been greatly expanded. According to Section 18.3b, "examiners should not use this chapter to rate pain related impairment for any condition that can be adequately rated on the basis of the body and organ impairment systems given in other chapters of the Guides." This chapter is not to be used in combination with other methods to measure impairment due to sensory pain (Chapters 13, 16 and 17).
For OWCP purposes, this chapter should be applied in the following manner:
a. The physician measures organ function according to other chapters in the Guides and establishes an impairment percentage.
b. If the conventional impairment adequately encompasses the burden produced by pain, the formal impairment rating is as determined above.
c. If pain-related impairment appears to increase the burden of the individual's condition slightly, the examiner can increase the percentage found in step (a) by up to 3%.
d. If pain-related impairment appears to increase the burden of the individual's condition substantially, the examiner can increase the percentage found in step (a) by 3%.
6. A new method for the recording of range of motion (ROM) measurements is offered in the fifth edition of the Guides. This format, which is known as the SFTR method, is expected to minimize errors of transcription and to facilitate communication among examiners. Specific characteristics of this format are described in the Appendix, pages 593-598. Examining physicians may report ROM measurements in this fashion.
7. The criteria for determining impairment due to asthma have been updated. Table 5-9, "Impairment Classification for Asthma Severity", and Table 5-10, "Impairment Rating for Asthma", should be used when the pulmonary impairment in question is due to asthma. The whole person impairment thus obtained should be converted to impairment of the lungs in the usual manner. Table 5-12, "Impairment classification for Respiratory Disorders, Using pulmonary Function and Exercise Test Results," should not be used in asthma cases.
8. Respiratory impairment criteria now incorporate the lower limits of normal (according to age and gender) for the basic pulmonary function tests (Tables 5-2a through 5-7b and 5-12). This means that abnormal pulmonary function studies are defined by two criteria: (1) the measurement is lower than the predicted value, AND (2) the measurement is lower than the predicted lower limit of normal for the particular age and gender.
9. New methods are used for the calculation of visual impairment ratings. Measurements have been changed and the extra scale and losses for double vision (diplopia) and lack of a lens (aphakia) have been deleted.
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FECA BULLETIN NO. 01-06
Issue Date: January 2, 2001
Expiration Date: January 1, 2002
Subject: Compensation Pay: Compensation Rate Changes Effective January 2001
Background: In December 2000, the President signed an Executive Order implementing a salary increase of 2.70 percent in the basic pay for the General Schedule. The applicability under 5 U.S.C. 8112 only includes the 2.70 percent increase in the basic General Schedule. Any additional increase for locality-based pay is excluded. The adjustment is effective the first pay period after January 1, 2001.
Purpose: To inform the appropriate personnel of the increased minimum/maximum compensation rates, and the adjustment procedures for affected cases on the periodic disability and death payrolls.
The new rates will be effective with the first compensation payroll period beginning on or after January 1, 2001. The new maximum compensation rate payable is based on the scheduled salary of a GS-15, Step 10, which is now $103,623 per annum. The basis for the minimum compensation rates is the salary of $16,015 per annum (GS-2, Step 1).
The minimum increase specified in this Bulletin is applicable to Postal employees.
The effect on 5 U.S.C. 8112 is as follows:
|
Effective January 2, 2001 |
Minimum |
Maximum |
|---|---|---|
|
Monthly |
$1,000.94 |
$6,476.44 |
The effect on 5 U.S.C. 8133(e) is to increase the minimum monthly pay on which compensation for death is computed to $1,334.58, effective January 2, 2001. The maximum monthly compensation as provided by 5 U.S.C. 8133(e)(2) is increased to $6,476.44 per month.
Applicability: Appropriate National and District Office personnel
Reference: Memorandum For Directors of Personnel dated December 2000; and the attachment for the 2001 General Schedule.
Action: ACPS will update the periodic disability and death payrolls. Any cases with gross overrides will not have a supplemental record created. Thus, the cases with gross overrides must be reviewed to determine if adjustments are necessary. If adjustment is necessary, a manual calculation will be required.
1. Adjustments Dates.
a. As the effective date of the adjustment is January 28, 2001, there will be no supplemental payroll necessary for the periodic disability and death payrolls.
b. The new minimum/maximum compensation rates will be available in ACPS on or about January 19, 2001.
2. Adjustment of Daily Roll Payments. Since the salary adjustments are not retroactive, it is assumed that all Federal agencies will have ample time to receive and report the new pay rates on claims for compensation filed on or after January 1, 2001. Therefore, it will not be necessary to review any daily roll payments unless an inquiry is received. If an inquiry is received, verification of the pay rate must be secured from the employing establishment.
3. Minimum and Maximum Adjustment Listings. Form CA-842, Minimum Compensation Pay Rates, and Form CA-843, Maximum Compensation Rates, should be annotated with the new rate information as follows:
|
CA-842 |
|||||
|
1/02/01 |
46.20-69.30 |
230.99-346.49 |
46.20 |
230.99(923.96) |
1,334.50 |
|
CA-843 |
|||||
|
1/02/01 |
298.91 |
1,494.56 (5,978.24) |
6,476.44 |
||
4. Forms. CP-150, Minimum/Maximum Compensation, will be generated for each case adjusted. It should be noted that this adjustment process re-calculates EVERY ACPS record from very beginning to current date, thus, it may be that minor changes in the gross compensation are noted; this is not necessarily incorrect. Notices to all payees receiving periodic compensation payments will be generated, informing them of potential changes to their compensation benefits.
The notices will be sent as an attachment to the Benefit Statement generated after each periodic cycle. Manual adjustments necessary because of gross overrides should be made on Forms CA-24 or CA-25 with a notice sent to the payee by the District Office.
Disposition: This bulletin is to be retained in Part 5, Benefit Payments, Federal (FECA) Procedure Manual, until the indicated expiration date.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
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FECA BULLETIN NO. 01-07
Issue Date: January 31, 2001
Expiration Date: January 30, 2002
Subject: BPS - Revision in the Reimbursement Rates Payable for the Use of Privately Owned Automobiles Necessary to Secure Medical Examination and Treatment.
Background: Effective January 22, 2001, the mileage rate for reimbursement to Federal employees traveling by privately-owned automobiles is increased to 34.5 cents per mile by GSA. No restriction is made as to the number of miles that can be traveled. As in the past, determination has been made to apply the applicable rate to disabled FECA beneficiaries traveling to secure necessary medical examination and treatment.
Applicability: Appropriate National Office and District Office personnel.
Reference: Chapter 5-0204, Principles of Bill Adjudication, Part 5, Benefit Payments, Federal (FECA) Procedure Manual; Instruction CA-77, Instructions for Submitting Travel Vouchers; and 5 USC 8103.
Action: Instruction CA-77, Instructions for Submitting Travel Vouchers, has been revised to reflect the indicated rate change. A copy of the revised instructions is attached to this bulletin and may be reproduced at local levels. It will not be necessary to search and locate vouchers processed subsequent to February 1, 2001; however, if inquiry is received, appropriate adjustment should be made. Vouchers being processed for travel periods after February 1, 2001, may be adjusted to reflect this increase.
Disposition: This Bulletin should be retained in Chapter 5-0204, Principles of Bill Adjudication, Federal (FECA) Procedure Manual.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Attachment
Distribution: List No. 2 -- Folioviews Groups A and D
(Claims Examiners, All Supervisors, Systems Managers, District Medical Advisors, Technical Assistants, Rehabilitation Specialists, and Fiscal and Bill Pay Personnel)
Attachment 07-01
Instruction for Submitting Travel Vouchers For reimbursement of travel and related expenses under the Federal Employees Compensation Act.
Instructions for Submitting Travel Vouchers U.S. Department of Labor (For reimbursement of travel and related expenses Employment Standards Administration under the Federal Employees' Compensation Act) Office of Workers' Compensation Programs
-----------------------------------------------------------------------------------------------------------------------
Note: Any item not in conformity with the following instructions and not legible will be deducted from the voucher. Both forms SF-1012 and SF-1012a MUST be submitted with a valid case file number.
1. Claim for necessary and reasonable expense incident to travel authorized in accordance with provisions of the Federal Employees Compensation Act may be submitted for consideration on Voucher Forms SF-1012 and SF-1012a. Travel must be by shortest route and, if practicable, by public conveyance (streetcar, bus, boat, or train).
2. The Office will promptly reimburse all bills received on the approved form and submitted in a timely manner. However, no bill will be paid for expenses incurred if the bill is submitted more than one year beyond the calendar year in which the expense was incurred or the service or supply was provided, or more than one year beyond the calendar year in which the claim was first accepted as compensable by the Office, whichever is later (per CFR §10.413).
3. Payment will be made for taxicab fare or the hire of special conveyance where streetcars, buses, or other public and regular means of transportation are not available, except where these cannot be used because of the injured employee's disability. If claim is made for payment of expenses for taxicabs or hire of special conveyances, a full explanation must be made showing the necessity thereof.
4. Reimbursement for transportation by automobile owned by an employee or a member of his/her immediate family or another Government employee, may be claimed when no public conveyance is available or where the physical condition of the injured employee requires the use of special conveyance.
Mileage expenses will be reimbursed at the following rates for travel during the following periods:
| Dates | Rate |
|---|---|
|
January 1, 1995 – June 6, 1996 |
30 cents per mile |
If mileage expense is claimed prior to January 1, 1995, contact your OWCP district office for rates.
5. Claim may be made for parking fees. If travel must be over a toll route, toll charges may be claimed. The voucher must show the locations where travel began and ended, mode of travel, and name of the transportation company (if by public conveyance). List each item of expense separately, showing the date incurred, place, and cost of the travel.
6. There will be no reimbursement for meals or lodging when travel is for less than 12 hours in total. If the authorized travel was for longer than 12 hours, and a claim for meals or lodging is made, the dates and hours must be shown on the voucher. The necessity for lodging must be explained in detail. All charges must be reasonable, and will be reimbursed at the per diem rate for the locality of travel.
7. Any stopover or delay en route should be carefully explained. If several trips are covered by the same voucher, list each separately, indicate the purpose of each trip, and secure the approval of the attending physician, certifying that the dates are correct according to his/her records.
8. Original itemized receipts made out in factor of the person making payment, signed in ink or indelible pencil by the person receiving payment must be furnished for all items in excess of $75.00.
9. After a voucher SF-1012 has been completed, it must be signed in ink or indelible pencil in the space provided for the payee.
10. The travel voucher should not be submitted if there is no expense claimed.
INSTRUCTION CA-77
Revised January 2001
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FECA BULLETIN NO. 01-08
Issue Date: April 23, 2001
Expiration Date: April 24, 2002
Subject: Comp Pay - Extra Pay for Firefighters
Background: In 1989, OWCP determined that pay rates for COP and compensation would properly include extra pay authorized under the Fair Labor Standards Act, 29 U.S.C. 207(k), for firefighters, emergency medical technicians, and other employees who earn and use leave on the basis of their entire tour of duty, and who are required to work more than 106 hours per pay period. This policy was first addressed in FECA Bulletin 89-26, and it now appears in FECA Procedure Manual Chapter 2-900, paragraphs 7b(21) and 8c.
However, the Federal Firefighters Overtime Pay Reform Act of 1998 (Public Law No. 105-277) amended Title 5 of the U.S. Code to define hours worked by firefighters in excess of 106 biweekly, or 53 weekly, as overtime. It also states that firefighters shall not receive premium pay authorized by other provisions of subchapter V of chapter 55 of Title 5. The effective date of this provision was the first day of the first pay period after October 1, 1998, which is presumed to be October 11, 1998, for the purposes of this bulletin. As Section 5 U.S.C. 8114(e) of the FECA bars inclusion of overtime pay in pay rates for compensation purposes, firefighters with pay rate effective dates on or after October 11, 1998 were not entitled to receive the "extra pay" discussed in PM 2-900.7b(21) and 8c. This change in policy was addressed in FECA Bulletin 00-05.
In December 2000, Public Law 106-554 again amended Section 5 U.S.C. 5545b(d) to include a paragraph stating that, for the purpose of computing pay under Section 5 U.S.C. 8114, the pay of a firefighter covered by Section 5 U.S.C. 5545b for hours in a regular tour of duty shall not be considered overtime pay. This amendment is deemed effective as if it had been enacted as part of the Federal Firefighters Overtime Pay Reform Act of 1998.
Reference: FECA Bulletin 89-26; FECA Bulletin 00-05; FECA Procedure Manual Chapter 2-900.7b(21) and 8c.
Purpose: To advise claims staff of the provisions of Public Law No. 106-554 as they apply to the pay rates of firefighters.
Applicability: Claims Examiners, Senior Claims Examiners, Claims Supervisors, Fiscal Officers, Technical Assistants, Hearing Representatives, and Hearing Examiners.
Action:
1. The procedures that follow apply only to GS-081 firefighters who are covered by Section 5 U.S.C. 5545b. These firefighters have regular tours of duty averaging at least 106 hours per biweekly pay period and generally earn and use leave on the basis of their entire tour of duty. Some firefighters work fewer hours per pay period and, because their pay rates should never have included the extra increments that are the subject of this bulletin, no adjustments are needed.
2. For firefighters with pay rate effective dates on or after October 11, 1998, "extra pay" for hours in the regular tour of duty should now be included in their pay rates. This inclusion is retroactive to October 11, 1998.
3. Under the Federal Firefighters Overtime Pay Reform Act of 1998, there are two categories of firefighters based on type of work schedule: (1) those with regular tours of duty generally consisting of 24-hour shifts and (2) those with extended tours that are built on top of a 40-hour basic workweek (usually five 8-hour shifts). Different pay computation rules apply to each category.
a. For firefighters who generally work 24-hour shifts (which is the most common situation), use the following formula:
(1) Annual salary / 2756 (53 hours of regular pay per week X 52 weeks) = firefighter hourly rate
(2) Firefighter hourly rate X 106 hours = biweekly base pay
(3) Firefighter hourly rate X 1.5 = "extra pay" rate (subject to GS-10, step 1, cap as described in paragraph 4 below)
(4) "Extra pay" rate X (hours in regular tour in excess of 106 hours) = biweekly "extra pay"
(5) (Biweekly base pay + biweekly "extra pay") / 2 = weekly pay rate
Note: Most 24-hour shift firefighters have a regular biweekly tour of 144 hours (six 24-hours shifts) consisting of 106 regular hours and 38 "extra pay" hours; thus, 38 hours (144 - 106) would be used in step (4) above.
b. For firefighters with an extended regular tour built on top of a 40-hour basic workweek, use the following formula:
(1) (Annual salary / 2087) X 80 hours = biweekly base pay
(2) Annual salary / 2756 = firefighter hourly rate
(3) Firefighter hourly rate X 26 hours = additional biweekly base pay
(4) Firefighter hourly rate X 1.5 = "extra pay" rate (subject to GS-10, step 1, cap as described in paragraph 4 below)
(5) "Extra pay" rate X (hours in regular tour in excess of 106 hours) = biweekly "extra pay"
(6) (Biweekly base pay + additional biweekly base pay + biweekly "extra pay") / 2 = weekly pay rate
Note: A common schedule would be a 40+16 weekly tour, which translates into a biweekly tour of 112 hours, including 6 "extra pay" hours to be used in step 5 above.
4. The Federal Firefighters Overtime Pay Reform Act of 1998 provides overtime ("extra pay") for hours in the regular tour of duty to both FLSA nonexempt and exempt firefighters. The weekly pay rates are computed in the same manner for both types of firefighters except there is a cap on the "extra pay" hourly rates for FLSA exempt firefighters. The cap is set at 1.5 times the GS 10, step 1 hourly rate (computed using the 2087 divisor) but the capped rate may not fall below the individual firefighter's hourly rate of basic pay.
5. When making loss of wage-earning capacity determinations for firefighters with pay rate effective dates prior to October 11, 1998, the step increases granted by Public Law No. 105-277 should not be considered in calculating the current pay for grade and step when injured. Rather, the original grade and step should govern the figure used.
6. District office managers will be advised by memorandum of any cases in their respective jurisdictions for firefighters (occupation code GS-081) with pay rate effective dates on or after October 11, 1998. These cases must be examined to determine if the pay rates are accurate, and if not, the pay rates must be adjusted.
Disposition: Retain until the indicated expiration date.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 1-Folioviews Groups A and D
(Claims Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists and Staff Nurses)
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FECA BULLETIN NO. 01-09
Issue Date: February 5, 2001
Expiration Date: February 5, 2002
Subject: COP Nurse Intervention
Background: Amended FECA Bulletin 00-15, issued September 18, 2000, incorporated changes to the Continuation of Pay/Return to Work (COP/RTW) initiative. These changes enabled district offices to identify cases in need of prompt adjudication, and assisted Claims Examiners (CE) in prioritizing their adjudication efforts. The changes included the addition of four triage codes to be used in cases with no full-time return to work: "1" - no return to work due to surgery, invasive diagnostic testing, physical therapy, hospitalization or catastrophic injury; "2" - no return to work due to other reasons; "3" - part-time return to work; "4" - claimant not cooperating with nurse. The Bulletin also discussed changes planned for the automated system that would fully utilize the triage codes and facilitate prompt Quality Case Management (QCM) action on triaged cases. Those automated changes have now been implemented.
Purpose: To describe the automated changes and provide guidelines for Claims Examiner/Telephonic Case Manager (TCM) actions relevant to COP/RTW case management.
Applicability: Regional Directors, FEC District Directors, Claims Examiners, Supervisors, Technical Assistants, Staff Nurses and Vocational Rehabilitation Specialists.
Action:
COP/TCM Nurse Responsibilities
1. The web-based "home page" has been updated to include a "TRIAGE CODE" section. (See Attachment 1 - Sample COP/RTW Case Update screen.) The COP/TCM should "click" on the appropriate triage code description once he or she has determined that the claimant: 1) is not working due to surgery, diagnostic testing or physical therapy; 2) is not working for other reasons; 3) has returned to work part-time; or 4) is not cooperating with nurse intervention. Triage code "4" should only be entered if a claimant specifically expresses unwillingness to cooperate and the COP/TCM is unable to obtain return to work information from the employer.
2. If no triage code is indicated at the end of the COP/TCM's 30-day time limit, the system will automatically choose a triage code upon locking access to the home page. When no return to work is indicated, the system will choose triage code "2". When "RETURNED TO WORK TYPE" is "unknown" or "part time", the system will chose triage code "3".
3. The format of the case closure worksheet has been revised. (See Attachment 2 - Sample COP/RTW Case Worksheet.) This updated version should be used for all cases.
Claims Examiner Responsibilities
1. When the CE enters part-time return to work data in the COP/RTW Case Update screen (Case Management Screen 41), the system will record a triage code "3" and lock out access to the web-based home page.
2. Short-form closure cases with triage code "3" in which the claimant has been off work for 45 or fewer days will flip open for adjudication with an expired call-up noting, "CLOSED CASE REOPENED-COP/TCM CASE WITHOUT FULL-TIME RTW". Short-form closure cases with triage code "2" in which the claimant has been off work for 35 or more days will flip open for adjudication with an expired call-up noting, "CLOSED CASE REOPENED-CLAIMANT STOPPED WORK OVER FIVE WEEKS AGO". Short-form closure cases with triage codes "1" and "4" will "flip" open for adjudication with an expired call-up noting, "CLOSED CASE REOPENED-CLAIMANT NOT WORKING-TRIAGE PRIORITY". The CE should prioritize adjudication of these cases in the order of the triage codes (i.e. triage code "1" is the top priority, triage code "2" is the next priority, etc.).
3. Acceptance of a case with a triage code will trigger a prompt stating, "ACCEPTED CASE WITH NO RTW OR RTW PART-TIME - INITIATE QCM". The CE should immediately initiate field nurse referral. Manual creation of a QCM record is no longer required. Both acceptance of a triaged case and entry of a triage code on an accepted case will automatically create a QCM record with a new QCM category "T". The QCM TRACK DATE will be set to the DATE STOPPED WORK and a new status code "TCC - Triage COP Case" will automatically be entered. For those cases with triage code "3", work status code "PLP - pre-QCM RTW LD PT" will also be automatically entered using the date of return to work. Category "T" cases will not be included in District Office Lost Production Days (LPD) counts.
4. Entry of TPCUP decision codes A1/A2 and I1/I2 will automatically adjust the QCM TRACK DATE, eliminating the need for CE's to manually adjust the QCM records. In cases with no work status code, the TRACK DATE will be changed to the first date claimed on the paid Form CA-7 (date wage loss began). In cases with work status code "PLP", the TRACK DATE will be changed to the decision date on the first paid Form CA-7. The QCM category will also be changed to "A" or "B" as appropriate.
5. In category "T" cases where the claimant returns to full-time work during the COP period, the CE will enter a new work status code, "TRC - Triage Case with RTW during COP Period". The system will automatically "zero out" the QCM record in cases with the "TRC" code, so manual adjustment of the QCM category is no longer required.
Systems Manager
1. Three existing Online Query System 2 (OQS2) reportsC"Traumatic Injury Cases UN/UD", "Traumatic Injury Cases UN/UD and Controverted", and "LT/NLT Closures Now Reopened"Cwill be revised to include triage codes. The "Adjudication Triage Report" (CASE649) is supplanted by these revised reports and will be removed.
2. The "No Intervention Report" (CASE633) will be revised to include triage codes.
3. A new OQS2 report of "COP QCM Cases with no Action" will be available to identify QCM category "T" records where staff nurse referral has not occurred. The "QCM Referral Triage Report" (CASE650) is supplanted by this new report and will be removed.
4. The weekly "COP-QCM Cases Report" (CASE651) is no longer necessary as a result of the automated changes and will be removed.
Disposition: Retain until the expiration date or until superseded.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 1-Folioviews Groups A and D (Claims
Examiners, All Supervisors, District Medical Advisors, Systems Managers, Technical Assistants, Rehabilitation Specialists and Staff Nurses)
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FECA BULLETIN NO. 01-10
Issue Date: April 30, 2001
Expiration Date: April 29, 2002
Subject: Bill Pay/BPS – Sampling of Bills
Background: The supervisory sampling of bills was initiated in 1994 (FECA Bulletin 94-10), with the enhancement to the Medical Bill Processing System. The procedure was reissued and updated in 1998 (FECA Bulletin 98-05) because of reports from the Office of the Inspector General citing numerous errors in bill processing and the finding in several accountability reviews that bill sampling was not being conducted in a number of district offices.
Results of the medical quality index introduced during the 2000 accountability reviews suggest that processing errors have decreased in number and indicate that bill sampling is routinely conducted in the district offices.
However, during the same period, multiple changes have occurred within the FECA program that impact on the bill sampling procedures. Implementation of the Correct Coding Initiative (CCI) increased the complexity of the automated editing and bill resolution decisions, as well as the need for accurate keying. Medical coding specialists have joined the staff in the district offices to resolve bills suspended for complex issues, to serve as medical provider liaisons, and to conduct quality assurance activities. Imaging of case information and medical bills in the district offices has altered some of the bill resolution manual processes.
This bulletin reviews and updates the bill sampling procedures to improve the probability of detecting significant errors and trends in bill processing, and to take into account the changes mentioned above.
Purpose: To transmit updated procedures for the sampling of bills.
Reference: FECA Bulletins 94-10 and 98-05.
Applicability: Regional Directors, District Directors, Fiscal Officers, Bill Payment Supervisors, Medical Coding Specialists, and appropriate National Office personnel.
Action:
1. The Medical Coding Specialist (MCS) will sample bills processed through the BPS on a monthly basis. The MCS will examine all the bills in the sample in accordance with the instructions in Attachment 1 and complete the Bill Sampling Worksheet.
2. By the tenth day of each quarter, the MCS will provide a report of the previous quarter's findings to the District Director. The report should include (a) the worksheet with the total number and percent of bills with errors and subtotals for each type of error, and (b) recommended corrective action(s).
3. A copy of the quarterly report (findings and corrective actions) will be provided to a designated National Office Medical Coding Specialist, no later than the 20th day of the quarter, along with a time table for corrective actions. The National Office Medical Coding Specialist will compile a national level report for management staff.
4. Each sample will be selected on an automated basis by the Monthly Bill Sampling OQS2 report and by retrieving DO information from a shared drive. The DO systems manager will import the case information into a sampling worksheet and route it to the MCS. The sample will comprise 32 line items that failed one or more of the following edits according to records in the b22 table: 301, 364, 371, 373, 375, 377, 708, 716, 738, 746, 758 and 766. Bills with bypass codes and bills paid using the AUTHO code will also be included. The sample should be composed of 69% edits, 25% bypass codes and 6% AUTHO codes. A back-up list will also be given to the MCS.
5. Separate batch sampling, as described in FECA Bulletin 98-05 is discontinued.
6. The Accountability Review and Management Review processes will verify that bill sampling is conducted in accordance with the above instructions and that corrective actions are implemented on timely basis.
Disposition: This Bulletin should be retained until incorporated into the Federal (FECA) Procedure Manual, or otherwise superseded.
DEBORAH B. SANFORD
Director for
Federal Employees' Compensation
Distribution: List No. 4--Folioviews Groups B and D
(All Supervisors, Fiscal Officers, Fiscal and Bill Pay Personnel, Systems Managers, and Technical Assistants)
Attachment 10-01
BILL SAMPLING INSTRUCTIONS:
1. For each bill in the sample, the MCS should obtain a Central history and an on-line history. The Central history contains receive date, payee address, authorizing initials and ineligible amounts and codes. The on-line history contains service dates, units, procedure codes, bypass codes, charge amounts and paid amounts, as well as data on denied bills and bills that reject in the Central processing. The BP040 reports will also be needed to obtain the payment address. Any information not available on these reports should be obtained through the Sequent database or by reviewing the physical case file.
2. The MCS receives the monthly bill sampling worksheet that includes all data elements: case file number, batch ID number, bill ID number, line item number, dates of service, failed edit, procedure or NDC code as applicable, and billed amount.
3. The MCS reviews the keying/initial processing of each bill in the sample by reviewing the following data elements and comparing the data in the automated history with the data as found on the bill:
a. Receive date
b. Date(s) of Service (DOS)
c. Procedure code
d. Modifier(s)
e. Units
f. If the bill was paid, is the address on the bill the same as the address paid?
g. If the bill was paid, was the correct provider selected (correct sequence number)?
The MCS introduces a check mark for every keying error found into the appropriate column in the Worksheet.
4. The MCS reviews the authorized amount initials. If the bill exceeded the maximum for the provider type, are the authorizing initials present on the bill? Are they in agreement with those in the system? Any error found in this process such as bills that exceed the DO provider maximum but that do not show authorizing initials, etc. is marked on the Worksheet.
Note: To complete this task, the MCS must have a list of the provider maxima in the local system.
5. The MCS reviews the amount charged. Are there any of the charge amounts on the bill different from the amounts on the history? If so, were changes made to the bill, and are the changes justified? Ineligible amount codes and amounts should be considered in this respect.
6. The MCS reviews the bills paid with the use of bypass codes. Was the bypass code correctly applied? If not, should another code have been used or was a bypass code necessary at all? Should the bill have been denied? Any misuse of a bypass code counts as an error.
7. The MCS reviews the use of the AUTHO code. This code is used only when necessary and where no existing CPT code is available and the bill, case file, or case notes show prior authorization of the procedure. When no such authorization exists or when there is no compelling reason for the use of the code, the MCS assigns an error in this category.
8. The MCS reviews adjudication decisions. When bills suspend for relationship edits, was the correct decision made with respect to the relationship of the service to the accepted condition(s)? Was an authorization given? Were the CCI edit suspensions properly resolved? Errors are assigned as warranted.
9. When the review is completed, the MCS totals the number and types of errors on the Worksheet, and analyzes results. The MCS communicates his/her findings and recommended corrective actions to supervisory personnel.
10. At the end of every quarter, the MCS prepares a formal report containing all the Worksheets, a narrative summary of findings, any recommended corrective actions with a suggested timetable, and a list of corrective actions from previous period that were completed during the quarter. He/she forwards this document to the appropriate supervisory personnel by the 10th day of the following quarter.
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FECA BULLETIN NO. 01-11
Issue Date: June 4, 2001
Expiration Date: June 4, 2002
Subject: Medical--Use of Physicians Directory System (PDS)
Background: On November 5, 1999, FECA Bulletin 00-01 was issued. That bulletin outlined the roles of all parties using PDS in the medical scheduling process. At the same time, the PDS was updated to include additional physicians, be more user-friendly, and allow management tracking of scheduling to assure adherence to the rotational system.
Recently, a new version of PDS (PDS32) has been piloted in the Seattle district office. This version will shortly be deployed in all district offices. The changes made in this version will be immediately visible to users, as the system is now Windows-based, allowing for use of the mouse as well as keyboard commands. The operation of the system, however, is substantially similar to the previous version, with some enhancements. The enhancements include the ability to both print an appointment report as the appointment is scheduled and produce a more detailed list of physicians when one is needed outside of the claimant's zip code (the list now includes those outside the next numerical zip code along with their city and state so that medical schedulers may use their knowledge of the region to schedule the closest possible appointment). Use of a physician outside of the claimant's home zip code will produce a mandatory note entry field so that the use of another zip code can be explained.
Reference: FECA Bulletin 01-11; PDS User Guide
Purpose: To familiarize district office personnel with the update of the PDS and provide job aids for users.
Applicability: Claims Examiners, Senior Claims Examiners, All Claims Supervisors, Medical Schedulers, District Medical Directors, Technical Assistants, Systems Managers, Staff Nurses, and Vocational Rehabilitation Specialists
Action:
All PDS users should familiarize themselves with the new PDS upon deployment in each district office. A job aid to assist medical schedulers in navigation of the system has been provided as Attachment 1 to this Bulletin. This is meant to supercede the PDS User Guide section for Schedulers.
Additionally, users are reminded that when a mandatory note field pops up, the note entered must fully explain the reason for either the use of a different zip code or the reason for the bypass (i.e. the entry of the word "other" in the note field required by an "O" bypass is not sufficient).
A job aid for managers has been created, and is Attachment 2. This will be incorporated into the PDS User Guide as well.
Disposition: Retain until incorporated in the Federal (FECA) Procedure Manual.
DEBORAH B. SANFORD
Director forFederal Employees' Compensation
Distribution: List No. 1--Folioviews Groups A and D (Claims Examiners, All Supervisors, Systems Managers, District Medical Advisers, Technical Assistants, Rehabilitation Specialists, and Staff Nurses)
Scheduling appointments:
Logging in:
You will be greeted with the following login screen:
You must enter or click on "Agree" to continue. Then, you will have to log on, using the same login ID as with the previous version of PDS. Once you have logged on, you'll get the following screen:
To schedule an appointment:
After logging in, the Cursor should already be positioned in the Case Number field. In the Case Number field type a case number. If you don't have the case number, you can choose to search using other criteria such as Claimant last name (more on this below). Then press the 'Tab' key (or click with the mouse) to move to the Appointment Type Field.
In the Appointment Type field select an appointment type by either pressing the 1st character of the available appointment types
I = IME
2 = Secop
A = Award
or by selecting the appointment type from the drop-down combo box. Then press the 'Tab' key (or click with the mouse) to move to the Specialty Field.
In the Specialty field select a specialty by entering the first letter of the specialty that you are looking for or use the mouse to view the drop-down list. Once this is done, click "Load" to select the next available doctor.
Once you have selected a doctor, you can assign the case to that doctor by either pressing the ALT + A keys simultaneously or clicking on "Assign." This will bring up the Schedule Doctor screen.
After you have set the appointment, you can document the appointment date on the Schedule Doctor screen by using the arrow keys on the keyboard or by clicking the arrows on that box. You can then tab to the appointment times box and set the time of the appointment the same way. You can then click "OK" to confirm scheduling. You will get confirmation that the appointment was scheduled for this doctor. You can then select "Print" and a record of the appointment will be printed for the file. Then, click the "Close" button to return to the main screen if you need to schedule another appointment.
Searching by claimant name:
Press this button to get the Select Case screen:
Enter the claimant's name into the last name field. A list of all cases with that last name will come up and you can scroll to find the correct one. When you locate it, you can select it by double-clicking it, or arrowing down to it and entering. Once the case selection record pops up, if the case selected is correct, click "OK" to schedule an appointment.
Bypassing a selected physician:
If the physician selected by PDS cannot be used, he or she should be bypassed, just as in previous versions of PDS. The reasons for bypass have not changed, and if there is question as to the validity of a bypass, FECA Bulletin 00-01 should be consulted.
After determining that a bypass is necessary and valid, press ALT + B keys simultaneously or click "Bypass." This will bring up the Bypass Doctor screen.
Find your reason for bypassing in the Select Bypass Reason box. If the bypass is any reason besides "Other," click "OK." If you have selected "Other," you must enter a note. Once you have clicked "OK," you will go back to the main form where the next available physician that meets the selection criteria will be displayed. You can then continue to schedule the appointment with the next available physician.
If you can't complete scheduling:
You can "pend" an appointment until you can finalize the scheduling by pressing "ALT + P" or clicking the "Pend" button. Click "OK" to confirm. If you later want to finalize this appointment, you can do so by selecting "Pending Appointments" on the "Appointments" menu.
Entering physician notes:
You can enter notes at any time during scheduling once you have selected the physician by either clicking "Notes" or by keying ALT + N. Once you have typed your note, either click "OK" or type ALT + O; this will confirm that your note has been saved and take you back to where you were.
Exiting the system:
You can exit PDS32 by either clicking on the "X" (as in other Windows programs) or clicking on "Exit" (the door symbol).
PDS: MANAGER'S MANUAL
Updating/Adding Physicians:
Under the "Physician" menu, you can either update a physician's record or add a new physician.
To update a physician's record:
Choose "Update Physician" from the "Physician" menu. This will bring up the following dialog box:
Then, to update a specific physician, enter that physician's last name (you can also browse by zip or specialty). You will get a listing of all physicians meeting that criteria. Select the physician you wish to update and either enter or double-click. This will bring up the Update Physician screen. You are then free to change any information on that physician's record.
To add a new physician:
Choose "Add Physician" from the "Physician" menu. This will bring up the following dialog box:
Once you have entered all information, either click on "Save" button or press the ALT + S keys simultaneously to save the information.
Updating/Adding Users:
Managers can add and update PDS users. Every PDS user MUST have an entry in this screen before logging in to PDS. Otherwise, PDS will not allow the user to log on. The User_ID must match the users Unix login ID.
To add a new user:
In the Utilities menu, click "Add/Edit Users." This will bring up a table of all users currently permitted PDS access. To add a new user, either select an empty row or create a new row in the grid by pressing the Insert key on the keyboard. Enter information in each field then use either the Arrow key or Tab key (or the mouse) to move to the next field. To save the new user information, select a different row in the grid and the user information will be automatically saved. Pressing the Esc key prior to moving to a different record cancels the New User record.
To Update an existing user:
In the table, select an existing user by using either the arrow keys or the mouse. Type over the existing information in the necessary field(s) then select a different record to automatically save the updated information. If a mistake is made while updating a user then the information can be changed again by typing over.
To Delete a User:
Select the user with either the mouse or the arrow keys. Press and hold CTRL + DELETE keys to display the Delete record confirmation dialog:
Click "OK" to remove the user from PDS.
Reports:
The reports available are the same as those in the prior PDS version. You can access any report by clicking on the "Reports" header and selecting from the pull-down menu. The types of reports are outlined below:
Appointment Log:
Selecting this option brings up the following screen:
You can select the report criteria you want, then click "Run." You will then get a window showing a preview of the report that will print. You can then either cancel or run the report.
Physician History:
To get a history of all appointments scheduled for a specific physician, select this option. The following screen will come up:
Enter the name of the physician whose history you want to view. Then, click "Locate." The physician's history will be displayed.
Physician Master:
This option allows you to get a list of all physicians within a zip code, and you may sort further by specialty. When you select this item, you get the following screen:
Once you enter the specifics for the report, you will get a print preview of the report, and you can either cancel or run the report.
Claimant History:
This allows you to obtain a record for all appointments scheduled through PDS for any claimant. Selecting this option brings up the following screen:
When you enter a last name, a listing of all claimants with that name who have had PDS appointments scheduled comes up. You can click on the desired claimant and then you will get a report to print out listing the details of all appointments scheduled.
Bypass Statistics:
This allows you to get a composite statistic of your office's use of bypass codes for any period. Selecting this item will bring up the following:
You can then specify the period for which you'd like to see bypass statistics and select "Run." When this is selected, you will get a preview of the report that will print and you can either cancel or run it.
Bypass History:
This will allow you to run a complete history of all appointments scheduled for a given period and list the bypasses logged in scheduling those appointments. Selecting this option gives you the following screen:
Once you enter the dates you wish to see and click "Run," you will again be given a print preview and be able to either run the report or cancel.
Physician Usage:
This allows you to display Physician Usage data based on the criteria you specify. You can select physician records by zip code/specialty/subspecialty with or without date range. You can further specify a threshold for number of exams/bypasses if desired.
When you select this, you get the following screen:
Once you enter the criteria for your usage search, you will get a print preview of the data, and you can either run it or just view it and cancel.
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