Medical billing problems are one of the most common problems
seen in OWCP claims. Invariably the
problem is not from OWCP, but from the medical providers themselves. Here are some common problems with medical
providers in OWCP claims and what you as a claimant can do to avoid them.
Enrollment
As an OWCP claimant, one of the first things you should do
when seeking medical treatment of your on the job injury is to confirm that
your chosen doctor is "enrolled" as a
medical provider with OWCP.
Enrollment
with OWCP has been a federal requirement since 2004. Enrollment is required for ALL
doctors who treat OWCP claimants. Enrollment means that the doctor has registered
with the government to medically treat OWCP claimants.
To find out if your doctor is enrolled you
should always demand that the doctor give you a written copy of his
enrollment. If the doctor is not
enrolled, find another doctor. If the doctor hesitates or seems unsure of
what you mean by enrolling with OWCP that is a red flag that he is not
likely enrolled. Find another doctor. If the
doctor demands your personal medical insurance information or cash for payment
before he even begins treatment of you that is a red flag he is not likely enrolled. Find
another doctor.
Once you have found an enrolled doctor to treat you on your
OWCP claim, then you can check the status of his billings, payments and medical
requests on your claim for yourself. You
can do this at any time. Simply go to
the OWCP medical processing website located here: https://owcp.dol.acs-inc.com/portal/main.do
Under the "FECA" tab, click on "claimant"
and fill in the requested information.
You will then be able to see all the billings, payments received and
medical authorizations requests submitted to OWCP by your doctor. Thus if your doctor's office tells you that
they are waiting on authorization from OWCP to perform a certain treatment on
your claim, you can verify if and when your doctor actually submitted that
authorization request to OWCP. If the
doctor's office tells you their bills have been denied by OWCP, then you can
verify if in fact the bills were denied (or even submitted), when and what was
the reason for denial.
Thus by finding and
using a doctor who is legitimately enrolled with the government for your OWCP claim, not only will you
be assured that your doctor apparently knows how to process your OWCP claim,
but you can also independently verify and check up on your doctor's dealings
with OWCP.
Billing Errors
OWCP medical claims processing can be a complicated paperwork bureaucracy. Medical billings must follow detailed bureaucratic
procedures to be processed and paid. As such,
medical billing problems are invariably due to paperwork or coding errors made
by the medical provider and not due to OWCP.
For example, as noted above, if the medical provider is not enrolled
with the government, his medical bills will be denied and returned regardless of
treatment. In addition, any billings submitted
without the medical provider's enrollment number provided in the proper
location will be denied and returned.
Each and every page of medical billing and report must contain the
claimant's name and OWCP number or they will be returned. Correct ICD-9 codes must be provided in proper
locations for billings or they will be denied and returned. Billings older
than one year from date of service will be returned and denied. The list of requirements and possible errors
goes on and on and it is the medical provider's responsibility - not the
claimant's - to be sure that medical reports and bills are submitted in proper
format to OWCP.
Medical Authorizations
It is very common for medical providers to tell OWCP
claimant's that they are waiting on OWCP to authorize a medical procedure for
the claimant. Again, claimant's can go
to the above given website to verify the status of any medical authorization
request sent by their doctor to OWCP.
If no such authorization appears on record, very likely the medical provider did
not submit a request to OWCP.
The OWCP does not
need to issue an authorization for every medical procedure. For example: Level 1 procedures (Office Visits, MRIs, and Routine Diagnostic Tests) do not require authorization. Level 2, 3 and 4 procedures require
authorization. These authorization
requests can be made onlineat http://owcp.dol.acs-inc.com or via by faxing a
completed authorization request and supporting documentation to 800-215-4901.
The Medical Authorization forms are available online at http://owcp.dol.acs-inc.com
And contrary to
common belief, an OWCP authorization is not
required when claimant is referred by her treating physician to a specialist
for a consultation. However, the
specialist must be enrolled as a Provider to be paid for the consultation visit.
Collections Agencies
Another common problem on approved claims is that a claimant
will receive a notice from a collections agency demanding payment on an unpaid
medical bill. The claimant should first
note whenever she receives such a collections notice, that collections notice is not from the OWCP. That collection notice came from her
doctor. The doctor is the one who has
turned his bill over to a collections agency; not OWCP. In addition, only the doctor can call off the collections agency; not OWCP. A claimant will have no luck trying to get
OWCP to take care of a collections agency trying to collect payment on a
medical bill. OWCP had nothing to do with
the collections claim or collections agencies.
So, can a medical provider turn his medical bills on an approved
OWCP claim over to a collections agency? No. Federal
law specifically exempts OWCP claimants from collections, claims of creditors
and assignments. Title 5 USC Section 8130.
A medical provider who has turned his
medical treatment billings on an OWCP claimant on an approved OWCP claim over
to collections is very likely violating federal law and should be reported to
the US Department of Labor. OWCP claimant's
who have received collections notices from their medical providers should first
verify the medical providers billing status with OWCP on the website given
above. If there is no record of such
billing in the OWCP claim, very likely, and very commonly, the medical provider
simply is seeking to avoid filing paperwork with the OWCP and trying to
collect money directly from the claimant rather than properly billing OWCP.
OWCP claimants should not permit their medical providers to bring collections
actions against them on approved OWCP claims.
