Federal Workers Compensation Coffee Break
Federal Workers Compensation Coffee Break
OWCP Form 915 Medical Reimbursement Tutorial Podcast episode 53 of Federal Workers Compensation Coffee Break Podcast
Podcast Overview of FORM 915 Medical Reimbursement
• Obtaining a Claimant Reimbursement Form
• Completing OWCP 915 for Medical Reimbursements
• Completing OWCP 915 for Pharmacy Reimbursements
Instructions for use of FORM OWCP-915 Medical Reimbursement
• The OWCP-915 is used to seek reimbursement for out-of-pocket medical expenses pertaining to the treatment of an accepted condition including (but
not limited to) medical treatments, prescription medications and medical
supplies.
• Please submit a separate reimbursement form for each provider where an out
of pocket expense was incurred.
• Please print clearly and legibly. Reference your OWCP Case ID on all
documentation.
• Maintain a copy of the completed OWCP-915 and supporting documentation
for your records
Form OWCP-915
This form is used to claim reimbursement for out-of-pocket medical expenses pertaining to the treatment of an accepted condition covered by the Federal Employees' Compensation Act, the Black Lung Benefits Act, and the Energy Employees Occupational Illness Compensation Program Act of 2000. Use this form to request reimbursement for medical expenses, transportation costs, loss of wages, and incidental expenses.
Form OWCP-915 can be used to claim reimbursement for:
• Incidental expenses
• Medical expenses
• Loss of wages
• Transportation costs
For more information on OWCP form 915 click on the podcast transcript
The podcast Dr. Taylor’s contact information is: https://fedcompconsultants@protonmail.com If you need a medical provider or assistance with an OWCP / DOL claim in Tampa, Pensacola Florida or Mobile Alabama you can make an appointment to see Dr. Taylor, or Dr. Sullivan at the clinic at FWC Medical Centers. To make a consultation with Dr. Taylor call the clinic at 813-215-4356 or go to our website at https://mrtherapycenter.com/or https://fedcompconsultants.com/
Welcome to another season of Federal Workers Compensation Coffee break Podcast. I am your host Dr. Taylor. I am glad to be back after a significant health problem last year that had me hospitalized and out of commission for a few months, but I am back and ready to start a new season. Thank you for all your prayers and well wishing, it was greatly appreciated.
For those of you who are new to the podcast …I am an OWCP consultant who has been assisting and working with clients for over 30 years in the work comp arena. I decided a few years ago to start giving back to government workers and other doctors by doing a free podcast to assist with all types of government related healthcare filings.
The only thing I ask for here at the podcast is that if you find this information to be helpful ….PLEASE leave a review, share the podcast with others and maybe send me an email to let me know that you benefitted from this free information. Here at this podcast we discuss all sorts of topics related to federal workers compensation, Department of Labor, OWCP, FECA ACT, FERS, longshore-maritime, DOD contractors, VA benefits. I cover these relevant topics in a short coffee break style format because we like to discuss topics that are related to helping you the government employee with filing your claim, understanding your rights and responsibilities, relevant rules and provisions.
I also like to cover topics that people are always wanting information on to help you successfully navigate the convoluted waters of federal claim filing. I do this to assist you, you and your doctor or your coworkers with claim filing denials or with appropriate filing of benefit claims, disability or injured worker claims.
Today is information on claim reimbursements for out of pocket medical expenses using OWCP form 915 based on some frequently asked questions. This is a two part series on tis reimbursement form. The first podcast is about understanding what to use the form for and what is covered and what is required in order to successfully fill out a reimbursement claim form. The second podcast will be about how to successfully fill out the form for medical, pharmacy and how to successfully submit the form. READY….OK…
Now lets get our coffee started and start on YOUR questions!
Form OWCP-915
This form is used to claim reimbursement for out-of-pocket medical expenses pertaining to the treatment of an accepted condition covered by the Federal Employees' Compensation Act, the Black Lung Benefits Act, and the Energy Employees Occupational Illness Compensation Program Act of 2000. Use this form to request reimbursement for medical expenses, transportation costs, loss of wages, and incidental expenses. Originally Form OWCP-915 cannot be submitted electronically; it was required be mailed to OWCP or handed over to your supervisor so it can be submitted to the district office. Lately I have seen some changes in this part with ECOMP and occupational safety and health filing this form for you.
In addition, you are required to submit separate OWCP-915 forms if you received medical services from different physicians and/or medical centers. In submitting the form, make sure to send over ORIGINAL bills in order to be reimbursed as copies are not accepted with the exception of said copies having the provider’s signature, showing clearly that you paid for the service. There’s also the issue of the maximum allowable charge which is set by the Director’s schedule which is a maximum dollar amount you can receive after you pay for a medical service regardless of how much you paid out-of-pocket for it. Sol lots of specifics to cover on this topic…let’s dive in and have your pen and paper ready AND BE PREPARED to stop and start this podcast and write some of this stuff down as we go.
Form OWCP-915 can be used to claim reimbursement for:
Incidental expenses
Medical expenses
Loss of wages
Transportation costs
OWCP requires that you submit this form after having reached maximum medical improvement. In addition, you may have to submit other forms if you already paid for your primary medical procedures as well as itemized bills.
If the employee has paid bills for medical, surgical or dental services, supplies or appliances due to an injury sustained in the performance of duty and seeks reimbursement for those expenses, he or she may submit a request for reimbursement on Form OWCP-915, together with an itemized bill on Form OWCP-1500, CMS-1500, OWCP-04 or UB-04 prepared by the provider and a medical report to OWCP. If the employee does not quality for continuation of pay (for 45 days), this form should be completed and filed with the OWCP as soon as pay stops. The form should also be submitted when the employee reaches maximum improvement and claims a schedule award. If the employee is receiving continuation of pay and will continue to be disabled after 45 days, the form should be filed with OWCP 5 working days prior to the end of the 45-day period. The CA-7 also should be used to claim continuing compensation, when a previous CA-7 claim has been made.
The provider of such service shall state each diagnosed condition and furnish the applicable ICD-9-CM or ICD-10-CM code, and identify each service performed using the applicable code, with a brief narrative description of the service performed, or, where no code is applicable, a detailed description of that service. If no code or description is received, OWCP will deny the reimbursement request and correction and resubmission will be required. The reimbursement request must be accompanied by evidence that the provider received payment for the service from the employee and a statement of the amount paid. Acceptable evidence that payment was received includes, but is not limited to, a signed statement by the provider, a mechanical stamp or other device showing receipt of payment, a copy of the employee's canceled check (both front and back) or a copy of the employee's credit card receipt or a form indicating a balance of zero to the provider.
Question: How do I get reimbursed for out of pocket expenses I've paid for authorized treatments, pharmacy expenses/medications, medical appliances, or medical supplies for a work-related injury?
Reimbursement for pharmacy expenses/medications, medical appliances and supplies, and medical, surgical, and dental services can be claimed using Form OWCP-915 "Claimant Medical Reimbursement Form". This form is available on the OWCP Web Bill Processing Portal. Click on Resources – "Forms and References" link. Put each date of service on a separate line. If you are requesting reimbursement for a co-pay, write "Co-Pay" in the "Description of Charge" field. Use a separate form for each provider you paid. Don't mix prescriptions and office visits on the same form.
A reimbursement claim for medical services, surgical services, medical appliances, or medical supplies must be accompanied by a copy of the OWCP-1500/HCFA-1500 "Health Insurance Claim Form" showing individual charges and signed by the medical Provider.
A reimbursement claim for pharmacy expenses/medications must be accompanied by a copy of the Universal Claim Form or other pharmacy statement showing the name of the drug, NDC code, quantity provided, cost, prescribing physician, and date the prescription was filled.
All reimbursement requests must be accompanied by proof of payment – a cash receipt, cancelled check, or credit card receipt.
Mail the completed OWCP-915 and related documentation to:
U.S. Department of Labor- OWCP/DFEC or provide it to your occupational safety and health personnel with your agency to provide to your claims examiner through the agency portal. At this point I would ECOMP it to your claims examiner as a back up. There has been no official change ein policy on how to submit these reimbursement forms but I have seen successful reimbursements in the las t couple of years using the ECOMP portal.
Be sure to include your claim number on EVERY page you send.
Question: If OWCP does not pay my provider's bill in full, am I required to pay my provider the difference between what was billed and what OWCP paid?
If a provider's bill is reduced by OWCP in accordance with its fee schedule or other tests of reasonableness, the provider is not allowed to charge you as a claimant for the remainder of the bill. If an authorized service has been rendered for your accepted work-related condition, you are not responsible for charges over the maximum allowed in the OWCP fee schedule. 20 C.F.R. §10.801 (d) provides that by submitting a bill and/or accepting payment, the provider signifies that the service for which reimbursement is sought was performed as described and was necessary. In addition, the provider thereby agrees to comply with all regulations concerning the rendering of treatment and/or the process for seeking reimbursement for medical services, including the fee schedule's limitation imposed on the amount to be paid for such services. See also 20 CFR §10.813.
If services were provided by a hospital, pharmacy or nursing home, the employee should submit the bill. Any request for reimbursement must be accompanied by evidence, as described in the above paragraph, that the provider received payment for the service from the employee and a statement of the amount paid.
OWCP may waive the requirements of listed above, if extensive delays in the filing or the adjudication of a claim make it unusually difficult for the employee to obtain the required information.
OWCP will not accept copies of bills for reimbursement unless they bear the signature of the provider, with evidence of payment. Payment for medical and surgical treatment, appliances or supplies shall be no greater than the maximum allowable charge for such service determined by the Director's schedule.
An employee will be only partially reimbursed for a medical expense if the amount he or she paid to a provider for the service exceeds the maximum allowable charge set by the Director's schedule. If this happens, OWCP shall advise the employee of the maximum allowable charge for the service in question and of his or her responsibility to ask the provider to refund, or credit to the employee's account, the amount he or she paid which exceeds the maximum allowable charge. The provider may request reconsideration of the fee determination.
If the provider fails to make appropriate refund to the employee, or to credit the employee's account, within 60 days after the employee requests a refund of any excess amount, or the date of a subsequent reconsideration decision which continues to disallow all or a portion of the appealed amount, the provider shall be subject to exclusion procedures.
If the provider does not refund to the employee or credit to his or her account the amount of money paid in excess of the charge which OWCP allows, the employee should submit documentation of the attempt to obtain such refund or credit to OWCP. OWCP may make reasonable reimbursement to the employee after reviewing the facts and circumstances of the case.
If an employee seeks reimbursement for transportation costs, loss of wages or incidental expenses related to medical treatment under this part, that employee may submit a reimbursement request on Form OWCP-957: Medical Travel Refund Request to OWCP along with all proof of payment. Requests for reimbursement for lost wages under this subsection must include an official statement from the employing agency indicating the amount of wage loss.
Last thing…that is important….OWCP requires that Form OWCP-915 must be accompanied by original receipts. Tax identification numbers may be written in above the pharmacy???s name. Do not submit bills on small pieces of paper. If the receipt is small, tape (not staple) it to a full size sheet of paper with claimant???s name and case number indicated in the upper right hand corner.
Well that does it for this episode of Federal Workers Comp Coffee break Podcast
I want to thank you for listening and want to remind you to share this podcast with other federal workers you think would benefit from this information. Also be kind enough to leave a review on the platform you found this podcast, like or subscribe to any of the major podcast platforms or our youtube channel so others will also find this information. Also if you need an approved medical provider for your DOL -OWCP Or Longshore case in Florida you can still find me in Tampa and Pensacola. To make a consultation with me to discuss your case or if you know someone if Florida who is recently injured you can call the clinic at 813-215-4356 or 813-877-6900 or go to our website at https://fedcompconsultants.com/ & https://mrtherapycenter.com/ Also if you are in another state and you want me to assist you with claim questions or assistance for your doctor you can email me at fedcompconsultants@protonmail.com or send me a message on the website at fedcompconsultants.com
I need to warm up this coffee and get going. As usual I want to thank all of you who put on that uniform, that badge, deliver that mail, take care of our veterans and make this government run… a big thank you. I do this for free just for you…We could not do this without all of the work all of you out there do…so a big thank you. And remember if you
have an injured federal claim and you need assistance….I am here to help!.
See you next time.
Off to get my coffee!
