OWCP Demands Reports, But Won't Pay Much If You Can Even Figure Out How To Bill

In an OWCP claim, it really all comes down to medical reports. Medical reports explain how your medical problem was caused by your job. And medical reports document, on an ongoing basis, how your injury or condition continues to limit your ability to work. Accurate, thorough and timely medical reports are the cornerstone of a successful OWCP claim.

That is why OWCP’s unfair and one-sided handling of medical reporting is so egregious. Here’s how it works:

Once your claim is approved, OWCP requires periodic medical reports from your doctor. These reports are to be written in the form of a narrative, discussing how you were hurt, what has transpired from then until now, and how your condition or need for treatment relates to that injury. This can be a complicated and time-consuming report for your doctor to prepare. But, here's just one of the many places that OWCP plays “gotcha.” Their letter will tell you that your doctor should bill them for this medical report, but they don’t provide explicit billing instructions. If you ask for clarification, they will tell you that the doctors' offices are supposed to know how to bill for what they do. (Guess what, they often don’t know how to bill OWCP.)

The billing code for this sort of a medical report is 99455 (for your treating doctor) and 99456 (if it is any other doctor). But, be advised that this code can only be used once a year on a case, and the doctor cannot bill for units of time, just the code. Your doctor will then get paid a set amount that is far below what OWCP pays their selected second-opinion and referee examiners. And what happens if you have two doctors--an orthopedic surgeon and a psychiatrist? What happens when your claims examiner asks for another report or wants to ask follow up questions from your doctor? What happens if you have a new or additional doctor who needs to spend a significant amount of time reviewing your records in order to prepare a report? According to OWCP, that's your problem; they are not going to pay for this.

Whereas your doctor will only get paid for one report per year, OWCP will frequently send you to multiple doctors and get multiple “clarification reports” in any one year. You better believe their doctors are paid for each and every report, and they are paid the going rate for their services.