OWCP and ICD-10 CM/PCS

The implementations of ICD-10 promises to create havoc and anarchy in the OWCP process as accepted conditions get reinterpreted, likely to the detriment of injured workers. Fortunately, we have a brief reprieve. Due to overwhelming concerns in the medical community as to the effect of this change, President Obama recently sign the SGR Patch bill, HR-4302, which delayed ICD-10 CM/PCS implementations until October 1, 2015.

Although there is a delay in the implementation of ICD-10 CM/PCS, OWCP is still requiring that providers use the revised HCFA 1500 claim form (version 2/12) to report services rendered using the current ICD-9. The implementation of ICD-10 promises to bring additional havoc and confusion to an OWCP process that places tremendous burdens and hurdles on injured workers who frequently have difficulty finding physicians who are willing to accept their cases due to OWCP operating a system that is designed purely for the convenience of those running OWCP with little if any consideration of the needs of injured workers and medical providers. Current versions of OWCP approved forms for FECA cases can be found through their website at the following location:

http://www.dol.gov/owcp/dfec/regs/compliance/forms.htm

OWCP and balance billing

Balance billing is a phrase that describes the situation where a medical provider tries to collect the amount that their bill was reduced when OWCP paid the provider's bill based upon the fee schedule. If a doctor charges $200 for an office visit, OWCP pays that bill in the amount of $120, and the provider then tries to collect the "balance" of $80 from you, that is called balance billing. Medical providers who accept payments in FECA cases are prohibited from balance billing and can be debarred for engaging in this practice. A medical provider agrees to accept what OWCP pays for a service and is not allowed to try to collect the balance from you. See 20 CFR 10.813: If OWCP reduces a fee, may a provider bill the claimant for the balance? A provider whose fee for service is partially paid by OWCP as a result of the application of its fee schedule or other tests for reasonableness in accordance with this part shall not request reimbursement from the employee for additional amounts. (a) Where a provider's fee for a particular service or procedure is lower to the general public than as provided by the schedule of maximum allowable charges, the provider shall bill at the lower rate. A fee for a particular service or procedure which is higher than the provider's fee to the general public for that same service or procedure will be considered a charge “substantially in excess of such provider's customary charges” for the purposes of §10.815(d). (b) A provider whose fee for service is partially paid by OWCP as the result of the application of the schedule of maximum allowable charges and who collects or attempts to collect from the employee, either directly or through a collection agent, any amount in excess of the charge allowed by OWCP, and who does not cease such action or make appropriate refund to the employee within 60 days of the date of the decision of OWCP, shall be subject to the exclusion procedures provided by §10.815(h).