Why does OWCP claim not to have received my CA-1032 or other information?

When you send something to OWCP it is scanned to your file. The file contains both scanned documents and an index, or table of contents, that points to the documents received to your file. It is quite common for a CA-1032 or other document to be incorrectly indexed to your file. Your claims examiner will look at that index and not see that a CA-1032 form is listed and assume you did not return it. If you sent in the form and then get a letter saying your claim is going to be suspended because you did not return the form, you should call in and speak to the customer service representative or your claims examiner and ask them to look at the incoming documents scanned to your file around the time the "missing" document should have arrived, not just the index. Most likely it is there and was just not coded correctly when it was scanned.

Get SSA to "pay" your attorney fees in your workers compensation case

This is a topic I posted on about 2 years ago. If you are receiving a check from OWCP and are also entitled to Social Security Disability payments from SSA, you can get SSA to "pay" your attorney fees as an "excludable expense." This also applies to other expenses related to your workers compensation such as paying for medical reports.

SSA has a document available online explaining how to report your attorney fees paid in connection with receiving FECA wage loss benefits from OWCP. The attorney fees (and other qualifying expenses) will be used to reduce the offset amount. Please click on the link below to SSA POMS - DI 52150.050 - Excludable Expenses, and carefully follow SSA's instructions:

link updated 1/26/15: the url below is correct, if the link does not work, cut and paste the link in your browser.

https://secure.ssa.gov/poms.nsf/lnx/0452150050
If this link does not work, do a google search for the document number  "0452150050"

OWCP announces a change of contact number for ACS effective 1/1/2015

Effective January 2, 2015 the ACS customer service number for questions related to provider enrollment, Federal Employees' Compensation Act (FECA) bill payment, and FECA medical authorization status is changing to a new toll free number, (844) 493-1966. Please continue to use the current ACS contact number of (850) 558-1818 until January 2, 2015, when that number will be disconnected. By providing a toll free number, we will be able to offer a more stable service for our stakeholders.

OWCP and other workers compensation systems no longer meet their basic goals

The idea behind workers compensation systems was that injured workers should get immediate benefits allowing them to not lose income and get the medical care they need to return to work as quickly as possible so as to avoid simple injuries becoming serious and the destruction of families due to lengthy waits to receive replacement income. Unfortunately, this system is presently failing many injured workers. This is an interesting article on how OWCP other state systems no longer provide the benefits that they were intended to provide because of the increasing complexity of a system that become more employer oriented by the day:
 http://www.nesri.org/news/2013/03/workers-compensation-the-systems-devastating-economic-impact-on-workers-lives

OWCP changes case jurisdiction for some FECA claims arising in Maryland to the Philadelphia district office

Continuing a trend that started some years ago, OWCP has taken more cases away from the Washington DC district office and assigned them to the Philadelphia district office. This means that anyone with a claim that has been reassigned should assume that their claim is going to receive a renewed level of scrutiny.

It is critical that your file has current narrative medical reports addressing causation and your ongoing need for benefits from OWCP. Many of the cases being transferred to Philadelphia have not gotten much attention in a long time.

As a general rule of thumb, you should be seeing a doctor regarding your conditions not less than once every four months. OWCP expects to see "current" (not more than six months old) medical information from your doctor about your injury.

If there is not current information in your file you should expect to be shopped for a second opinion examination.

Here is the link from OWCP explaining the reassignment of case jurisdiction.

http://www.dol.gov/owcp/dfec/casejurisdiction.htm

How do I find a physician willing to bill OWCP for treating me?

Unfortunately, because the federal employees compensation act process makes OWCP's claims actions unreviewable by any court, those running OWCP have created a system that is designed completely for their own convenience, not the convenience of the injured worker. Some years ago, OWCP began to require that medical providers "enroll" in the OWCP system so that they can get a "provider number" from OWCP. Without a provider number, physicians cannot bill OWCP for treating you. Medical providers already need to enroll with and get a number from Medicare. Why OWCP could not use that existing system, and supplement it with their own system for the obscure situation where a provider does not have a medicare number only makes sense if you recall that OWCP is only concerned about making this process convenient for OWCP. The practical effect is that many injured workers have a great deal of trouble finding a medical provider willing to treat them. If you are having difficulty finding someone to treat you, OWCP does have a tool that allows you to search their database for physicians who have provider numbers. If you click on the link below, and click on the "accept" button, then you select that you want to search in the "FECA" program. you can then do a search:

https://owcp.dol.acs-inc.com/portal/providersearch/agreement.do

The search function is fairly straightforward. One limitation is that certain specialties are not broken out. For instance, under specialties, they do not allow you to limit your search to "psychiatrist" or "psychologist". Therefore, to find a specialist who is not categorized, you need to first do a search in the geographic region you are looking in, then, for any physician who does not have a specialty listed, you can google that doctor's name and see whether that doctor is the type of specialist you are looking for.

If you are unable to locate a provider in your region willing to bill OWCP for treating you, you should document that you went through the list and bring this to the attention of your congressman and request a congressional inquiry. This problem is routinely brought to the attention of those running OWCP, they do not seem to be concerned. The only way they will fix this situation is if they receive scrutiny. If a congressman were to conduct hearings on this issue and ask the director of the program to explain why they are unconcerned with this situation, it might get fixed.

OWCP and travel reimbursements

Many OWCP claimants have great difficulty with getting their travel reimbursements processed correctly. In particular, OWCP makes this process particularly onerous on injured workers who are seeking specialized medical care that is not available in their own community as OWCP routinely refuses to reimburse for travel beyond fifty miles each way unless there are unique circumstances. Unique circumstances include that you live in a remote location and the care you need is not available locally or you have an unusual medical condition that cannot be treated locally. You will likely need a letter from a local doctor explaining why you need to travel more than 50 miles to get the type of care you need. The people writing these rules live in Washington, DC, a region spilling over with specialized medical care. While most claimants live in areas with far fewer doctors. Always keep in mind that OWCP's rules are written from OWCP's perspective, the design and operation of this program is to make things as convenient for those running this process, not for the needs of the injured workers. Following is a recent document that discusses this process: FECA BULLETIN NO. 14-02 Issue Date: January 29, 2014

---

Subject: Reimbursement of Travel Expenses for Claimants and Providers Providing Transportation Services
References:
5 U.S.C. §8103 of the Federal Employees' Compensation Act (FECA) provides that an injured employee is entitled to receive medical services, appliances or supplies which a qualified physician prescribes or recommends and which OWCP considers necessary to treat the work-related injury. This section further provides that an employee may be furnished necessary and reasonable transportation and expenses incident to the securing of such services, appliances and supplies when authorized. See 5 U.S.C. 8103. This circular briefly describes the circumstances and limitations on authorizing and paying for transportation services.
Effective August 29, 2011, 20 CFR §10.315, provides in pertinent part as follows with regard to payment for transportation to obtain medical treatment:

(a) The employee is entitled to reimbursement of reasonable and necessary expenses, including transportation needed to obtain authorized medical services, appliances or supplies. To determine what is a reasonable distance to travel, OWCP will consider the availability of services, the employee's condition, and the means of transportation. Generally, a roundtrip distance of up to 100 miles is considered a reasonable distance to travel. Travel should be undertaken by the shortest route, and if practical, by public conveyance. If the medical evidence shows that the employee is unable to use these means of transportation, OWCP may authorize travel by taxi or special conveyance.

(b) For non-emergency medical treatment, if roundtrip travel of more than 100 miles is contemplated, or air transportation or overnight accommodations will be needed, the employee must submit a written request to OWCP for prior authorization with information describing the circumstances and necessity for such travel expenses. OWCP will approve the request if it determines that the travel expenses are reasonable and necessary, and are incident to obtaining authorized medical services, appliances or supplies. Requests for travel expenses that are often approved include those resulting from referrals to a specialist for further medical treatment, and those involving air transportation of an employee who lives in a remote geographical area with limited local medical services.

Background: The change to requiring suspension of the reimbursement request and referring the request for claims examiner review whenever the request involves more than 100 miles per day of mileage reimbursement (Section A below) was effective January 17, 2013. The additional procedures outlined in this Bulletin were effective July 17, 2013.
Purpose: The purpose of this Bulletin is to address the manner in which travel procedure codes will be processed and paid by the Central Bill Processing (CBP) system when submitted for authorized examinations/treatments.
Applicability: Appropriate National Office and District Office personnel and FECA medical billing contractor.
Action:
A. Mileage Reimbursement for Examinations/Treatment. Periodically and in certain situations, travel to authorized examinations and/or treatment could exceed the allowable 100 mile distance outlined in 20 CFR 10.315(a) as noted above. When a claimant submits a reimbursement request (on Form OWCP-957, Medical Travel Refund Request) in excess of 100 miles for a single date of service, the bill will be automatically suspended and the CBP provider will send notification to the claims examiner seeking authorization. The notification sent by CBP will include the applicable date(s) of service, as well as the miles being claimed.

1. If the request is for a single trip and the mileage claimed is allowable, such as for a scheduled Second Opinion (SECOP) or Independent Medical Examination (IME), the Claims Examiner (CE) will simply authorize the reimbursement.

2. In limited circumstances it may be necessary for a claimant to travel more than 100 miles on a regular basis, such as to be seen by his/her treating physician or therapist if the claimant lives in a remote area. Upon receipt of notification from CBP in these instances, the CE should provide a range for this ongoing authorization, including both total miles and period that the authorization covers. This range should be calibrated to the claimant's treatment location and can extend up to 900 miles and up to six (6) months in length, using Procedure Code A0080.

3. Should the claimant exceed the miles authorized within this period, the CE will again be notified by CBP. If such travel is medically necessary for the work-related conditions, the CE has the authority to authorize an extension of the mileage, but can only do so after writing a memo to the case file to justify the increased number of miles allowable.

4. If the need for increased mileage continues past the initial six month authorization period, another authorization and memo to the file is also required for an additional 6 month period. Such authorization and documentation is required every 6 months.

5. If the proper authorization is on file, or the requested mileage does not exceed 100 miles for a single date of service, the bill will simply be processed by CBP. There will be no need for a notification to be sent to the CE.

B. Incidental Charges. Periodically, a claimant could incur incidental charges that may exceed $75.00 while travelling to authorized examinations.

1. If the claimant requests reimbursement for any of the following procedure codes (including those that require prior authorization), and the charge exceeds $75.00, the system will post Edit 501 (Service exceeds Allowable amount, Original Receipt/Invoice of the charge is required).

A0110 – Taxi
A0120 – Mini Bus
A0130 – Wheel Chair Van
A0140 – Air Travel
A0170 – Tolls/Parking
A0180 – Lodging
A0190 – Meals
A0200 – Lodging Escort
A0210 – Meals Escort

2. If the receipt/invoice is present, a notification will be sent to the CE to obtain authorization for the amount. However if the receipt/invoice is not present, the service will be denied for Edit 501. CBP will not send a notification to the CE if there are no receipts attached; it will simply deny the charge.

3. If the claimant submits a request for reimbursement of "TRANS," and there is no description present for using this code or the description is equal to "GAS," the system will post Edit 520 (A description of the service is required. Please provide the description and resubmit. Gas is not covered.) and deny the charge since charges for gasoline are not permitted in addition to mileage reimbursement.

Note: Where a claimant has been denied authorization for treatment or reimbursement for expenses related to transportation, a formal decision with appeal rights will be issued upon claimant request. Amounts paid (including amounts paid under the OWCP fee schedule) for medical services are not appealable to ECAB. See 20 C.F.R. § 10.625.]

C. Payment to Transportation Providers. The OWCP-1500 Form is to be used by those providing authorized transportation to claimants for medical treatment/appointments.

1. If the charge for these services exceeds $75.00, prior authorization is required and the bill must be accompanied with an invoice justifying the charge.

2. A provider must have prior authorization for any of the following transportation procedure codes if the charge billed exceeds $75.00:

A0100 - Taxi
A0110 – Bus
A0120 – Mini Bus
A0130 – Wheel Chair Van
A0140 – Air Travel
A0170 – Tolls/Parking

If there is not an authorization on file or the provider fails to submit an invoice, the system will post Edit 501 and deny the bill. In those instances where the amount being billed exceeds the amount authorized, CBP will send a notification to the CE requesting direction to extend the dollar amount of the authorization, to pay only the authorized amount, or deny the service.

3. If the billed charge is less than $75.00, no edit will post and the bill will be processed through the system, even without a receipt or invoice.

4. Providers who bill using mileage codes A0080 and/or A0090 will be paid based on the current GSA mileage rate, and prior authorization is required if the miles/units billed is for more than 100 miles/units for a single date of service. If an authorization is not on file, the CBP will deny the bill.

D. Mileage Reimbursement for Pharmacy Pick up

A claimant may claim mileage for pharmacy pick up to his or her local pharmacy; reimbursement is generally limited to the closest pharmacy by the shortest route.

Disposition: This bulletin is to be retained until the FECA PM has been updated.
DOUGLAS C. FITZGERALD
Director, Federal Employees' Compensation

New ECAB Judge appointed

I learned this afternoon that Iowa workers compensation commissioner Christopher Godfrey has been appointed to be Chief Judge of the Employees Compensation Appeals Board ("ECAB") starting on August 25, 2014. This is a critical position for OWCP claimants as ECAB is the highest level of review in a FECA claim for someone who has received an  unfavorable decision from OWCP. He is considered a friend of the working person and FECA claimants should be relieved that someone with Mr. Godfrey's qualifications has been appointed to this position.

OWCP Information for Medical Providers

If your medical providers are having difficulty getting authorizations or paid for treating you, OWCP provides instructions on their website that you should be sure your doctors' offices are familiar with:

http://www.dol.gov/owcp/dfec/medicalprovider.htm

Submitting information to OWCP

I frequently hear the complaint that "OWCP lost something that I sent in to my file." In a federal workers compensation claim, OWCP scans everything that you send them. If its got your file number on it, it is usually in your file. The folks who do the scanning are contractors, not your claims examiner. Anything you send to OWCP should have your file number clearly marked at the top right so that it is easy for someone to associate it with your file.

When items are scanned to your file, they are "coded" as correspondence, medical report, CA-1032 form, etc. A very common reason for a document to supposedly not be in your file is that it was incorrectly coded. For instance, it appears to me that about 75% of the time when one of my clients gets a nasty letter saying that the annual CA-1032 form was not received that is not actually true. OWCP did receive the CA-1032, but when it was coded, it was listed as correspondence or something other than being the CA-1032. Then, when your claims examiner reviewed incoming mail to see if it was listed as being received, since its coded wrong, it does not show up in the index to your file as being received.

OWCP and new injuries - send your medical records directly to OWCP

When you suffer a work injury, it is your burden to provide sufficient information to document how your job caused your injury. You need to collect all of your medical records, mark your file number on them, and send them all directly to OWCP.  If someone at your employing agency instructs you to send your records through them, you may do so, but do not rely on that person to submit your records to OWCP for you. The same goes for your physicians. Even if those offices tell you that they know what to do, it is crucial that you still collect all of your records, mark your file number on the top right of each page, and send them directly to OWCP yourself.

The most common reason for an initial claim to be denied is that the medical information that would have been enough to get your file approved did not get into the OWCP file because the injured worker thought someone else was supposed to do that for them.

Reimbursement of Travel Expenses in an OWCP claim

In a recent policy statement, OWCP clarified procedures for travel reimbursement. OWCP continues to hew to the 100 mile round trip limitation on travel, unless it is for a medical examination that OWCP directs you to attend. If you are traveling more than 100 miles round trip for medical care, be prepared for a constant harassment by your claims examiner. For claimants who live in rural areas or areas of the country where it is very difficult to find a medical provider willing to accept FECA benefits, you may want to complain to your congress person about this unreasonable situation.

FECA BULLETIN NO. 14-02 Issue Date: January 29, 2014

---

Subject: Reimbursement of Travel Expenses for Claimants and Providers Providing Transportation Services
References:
5 U.S.C. §8103 of the Federal Employees' Compensation Act (FECA) provides that an injured employee is entitled to receive medical services, appliances or supplies which a qualified physician prescribes or recommends and which OWCP considers necessary to treat the work-related injury. This section further provides that an employee may be furnished necessary and reasonable transportation and expenses incident to the securing of such services, appliances and supplies when authorized. See 5 U.S.C. 8103. This circular briefly describes the circumstances and limitations on authorizing and paying for transportation services.
Effective August 29, 2011, 20 CFR §10.315, provides in pertinent part as follows with regard to payment for transportation to obtain medical treatment:

(a) The employee is entitled to reimbursement of reasonable and necessary expenses, including transportation needed to obtain authorized medical services, appliances or supplies. To determine what is a reasonable distance to travel, OWCP will consider the availability of services, the employee's condition, and the means of transportation. Generally, a roundtrip distance of up to 100 miles is considered a reasonable distance to travel. Travel should be undertaken by the shortest route, and if practical, by public conveyance. If the medical evidence shows that the employee is unable to use these means of transportation, OWCP may authorize travel by taxi or special conveyance.

(b) For non-emergency medical treatment, if roundtrip travel of more than 100 miles is contemplated, or air transportation or overnight accommodations will be needed, the employee must submit a written request to OWCP for prior authorization with information describing the circumstances and necessity for such travel expenses. OWCP will approve the request if it determines that the travel expenses are reasonable and necessary, and are incident to obtaining authorized medical services, appliances or supplies. Requests for travel expenses that are often approved include those resulting from referrals to a specialist for further medical treatment, and those involving air transportation of an employee who lives in a remote geographical area with limited local medical services.

Background: The change to requiring suspension of the reimbursement request and referring the request for claims examiner review whenever the request involves more than 100 miles per day of mileage reimbursement (Section A below) was effective January 17, 2013. The additional procedures outlined in this Bulletin were effective July 17, 2013.
Purpose: The purpose of this Bulletin is to address the manner in which travel procedure codes will be processed and paid by the Central Bill Processing (CBP) system when submitted for authorized examinations/treatments.
Applicability: Appropriate National Office and District Office personnel and FECA medical billing contractor.
Action:
A. Mileage Reimbursement for Examinations/Treatment. Periodically and in certain situations, travel to authorized examinations and/or treatment could exceed the allowable 100 mile distance outlined in 20 CFR 10.315(a) as noted above. When a claimant submits a reimbursement request (on Form OWCP-957, Medical Travel Refund Request) in excess of 100 miles for a single date of service, the bill will be automatically suspended and the CBP provider will send notification to the claims examiner seeking authorization. The notification sent by CBP will include the applicable date(s) of service, as well as the miles being claimed.

1. If the request is for a single trip and the mileage claimed is allowable, such as for a scheduled Second Opinion (SECOP) or Independent Medical Examination (IME), the Claims Examiner (CE) will simply authorize the reimbursement.

2. In limited circumstances it may be necessary for a claimant to travel more than 100 miles on a regular basis, such as to be seen by his/her treating physician or therapist if the claimant lives in a remote area. Upon receipt of notification from CBP in these instances, the CE should provide a range for this ongoing authorization, including both total miles and period that the authorization covers. This range should be calibrated to the claimant's treatment location and can extend up to 900 miles and up to six (6) months in length, using Procedure Code A0080.

3. Should the claimant exceed the miles authorized within this period, the CE will again be notified by CBP. If such travel is medically necessary for the work-related conditions, the CE has the authority to authorize an extension of the mileage, but can only do so after writing a memo to the case file to justify the increased number of miles allowable.

4. If the need for increased mileage continues past the initial six month authorization period, another authorization and memo to the file is also required for an additional 6 month period. Such authorization and documentation is required every 6 months.

5. If the proper authorization is on file, or the requested mileage does not exceed 100 miles for a single date of service, the bill will simply be processed by CBP. There will be no need for a notification to be sent to the CE.

B. Incidental Charges. Periodically, a claimant could incur incidental charges that may exceed $75.00 while travelling to authorized examinations.

1. If the claimant requests reimbursement for any of the following procedure codes (including those that require prior authorization), and the charge exceeds $75.00, the system will post Edit 501 (Service exceeds Allowable amount, Original Receipt/Invoice of the charge is required).

A0110 – Taxi
A0120 – Mini Bus
A0130 – Wheel Chair Van
A0140 – Air Travel
A0170 – Tolls/Parking
A0180 – Lodging
A0190 – Meals
A0200 – Lodging Escort
A0210 – Meals Escort

2. If the receipt/invoice is present, a notification will be sent to the CE to obtain authorization for the amount. However if the receipt/invoice is not present, the service will be denied for Edit 501. CBP will not send a notification to the CE if there are no receipts attached; it will simply deny the charge.

3. If the claimant submits a request for reimbursement of "TRANS," and there is no description present for using this code or the description is equal to "GAS," the system will post Edit 520 (A description of the service is required. Please provide the description and resubmit. Gas is not covered.) and deny the charge since charges for gasoline are not permitted in addition to mileage reimbursement.

Note: Where a claimant has been denied authorization for treatment or reimbursement for expenses related to transportation, a formal decision with appeal rights will be issued upon claimant request. Amounts paid (including amounts paid under the OWCP fee schedule) for medical services are not appealable to ECAB. See 20 C.F.R. § 10.625.]

C. Payment to Transportation Providers. The OWCP-1500 Form is to be used by those providing authorized transportation to claimants for medical treatment/appointments.

1. If the charge for these services exceeds $75.00, prior authorization is required and the bill must be accompanied with an invoice justifying the charge.

2. A provider must have prior authorization for any of the following transportation procedure codes if the charge billed exceeds $75.00:

A0100 - Taxi
A0110 – Bus
A0120 – Mini Bus
A0130 – Wheel Chair Van
A0140 – Air Travel
A0170 – Tolls/Parking

If there is not an authorization on file or the provider fails to submit an invoice, the system will post Edit 501 and deny the bill. In those instances where the amount being billed exceeds the amount authorized, CBP will send a notification to the CE requesting direction to extend the dollar amount of the authorization, to pay only the authorized amount, or deny the service.

3. If the billed charge is less than $75.00, no edit will post and the bill will be processed through the system, even without a receipt or invoice.

4. Providers who bill using mileage codes A0080 and/or A0090 will be paid based on the current GSA mileage rate, and prior authorization is required if the miles/units billed is for more than 100 miles/units for a single date of service. If an authorization is not on file, the CBP will deny the bill.

D. Mileage Reimbursement for Pharmacy Pick up

A claimant may claim mileage for pharmacy pick up to his or her local pharmacy; reimbursement is generally limited to the closest pharmacy by the shortest route.

Disposition: This bulletin is to be retained until the FECA PM has been updated.
DOUGLAS C. FITZGERALD
Director, Federal Employees' Compensation

Why doesn't OWCP have a document that I sent?

I frequently hear from OWCP claimants who complain that they have sent a document in to OWCP yet the claims examiner claims it was not received. Any document you submit with your file number clearly marked on each page should be scanned and show up in your file. The most common reason that a claims examiner is telling you that something was not received into your file is that the document actually was received but it was coded incorrectly. For instance, many claimants receive notices that a completed 1032 form was not received  to their file. More often than not, the form is in the file, its just that it was not indexed as a 1032 form. If you are being told something is not in your file, and it should be in your file, telephone OWCP and ask the customer service rep or your claims examiner to look at the actual documents received to your file, not just the index. Its probably there but not properly indexed.

USPS and OWCP claims for hearing loss

Many Postal workers do not realize that the hearing loss they suffer over many years from noise exposure on their job is considered a compensable work injury by OWCP. It is important to be aware that a claim for this type of injury must be filed within three years of when you were last exposed to noise on the job. Sometimes a claim can be filed beyond the three year time limitation if the hearing loss was previously documented through a program of annual hearing tests conducted by the employing establishment.

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).

Time limitations to submit medical bills and requests for reimbursement of medical bills

OWCP's regulations (5CFR§10.803) provide that a medical bill, medical reimbursement request, or travel voucher must be submitted on an approved form and in a timely manner. Such bills will not be paid for expenses incurred if the bill is submitted more than one year beyond the end of the calendar year in which the expense was incurred or the service or supply was provided, or more than one year beyond the end of the calendar year in which the claim was first accepted as compensable by OWCP, whichever is later. Note that OWCP's bill processing software does not take into account the last portion of the above rule. Therefore, under the circumstances of a claim that was not approved right away, the time for submitting bills is extended to December 31 of the year following the year in which approval of your case or the relevant medical condition occurred. When such bills are routinely denied under these circumstances, you will need to follow up with your OWCP claims examiner and request that a "thread" be sent to the medical bill processor indicating that the bill was not untimely.