OWCP Fed Comp Claimant Reimbursement 915, 957a & 957b Forms tutorial (part 2 of 2)

Podcast -Overview --- Obtaining and Successfully Submitting  a Claimant Reimbursement Form for : 

• Completing OWCP 915 for Medical Reimbursements
• Completing OWCP 915 for Pharmacy Reimbursements
• Completing OWCP 957A and 975B for Travel Reimbursements

This is an OWCP - DOL Medical, Pharmacy & Travel Reimbursement Form Submission tutorial. This is part two of a two part series on how to successfully obtain reimbursements of medical services, expenses, and travel.
                                                 
                                    Form OWCP-915 (click on link for form)

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.  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. 

 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.

             OWCP 957A Travel Reimbursement-Mileage (click on link for form)

This form should be used for medically related travel covered by the Federal Employees' Compensation Act and the Energy Employees Occupational Illness Compensation Program Act.

              OWCP 957B Medical Travel Refund Request (click on link for form)

This form should be used for medically related travel refunds covered by the Federal Employees' Compensation Act and the Energy Employees Occupational Illness Compensation Program Act.

Under 50 Miles round trip: 

• File After Your Office Visit                                                       
• File Form OWCP-957: Medical Travel Refund Request.                                   
• Attach your physician’s ACS Web Bill Processing Portal approval

 Over 50 Miles round trip: File Before Your Office Visit (OK to try after your visit)

• Fax Transportation and Travel Authorization Request.
• Attach your physician’s ACS Web Bill Processing Portal approval.
• To get the form Google Authorization - Travel and Transportation 04-23-10"
• Or go to file:https://owcpmed.dol.gov/portal/Provider/Authorizations (click       on link above for form) 

The podcast Dr. Taylor’s contact information is: https://fedcompconsultants@protonmail.com If you need a medical provider

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Transcript

Welcome to another episode of of Federal Workers Compensation Coffee break Podcast. I am your host Dr. Taylor. I am an OWCP & Federal Health Care consultant who has been assisting and working with clients for over 30 years in the work comp arena. I  decided a few years ago that as my thank you to all the government and union employees that worked with me over the years to have a successful career in helping government workers with their injury, disability and retirement claims ….I would do something for free to  give back to government workers and other doctors or future doctors who want to participate in Federal Workers Compensation claims by doing a free podcast to  assist with all types of topics 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 like, share or leave a review of the  podcast for others to be able to find this subject matter material on the internet 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 (modeled after the lunch and learn style) to assist you….the government employee/contractor with filing your claim, understanding your rights,  responsibilities & relevant rules and provisions

 I also like to cover topics that people email me requested  information on… to help you successfully navigate the convoluted waters of all types 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 the 2nd part of the part 1 podcast of episode 53 on claim reimbursements for out of pocket medical expenses using OWCP form 915 based on some frequently asked questions. I also am going to cover the travel reimbursement form 957 A and B.

If you did not listen to episode 53 yet…go back and listen to that one before you listen to this 2nd episode.  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 we are going to do a side by side how-to with the actual forms for  successfully fill out the form for medical, pharmacy and how to successfully submit the form. So have these forms at the ready….pause the podcast here and get the forms and then come back and push play… READY….OK…

Now lets get our coffee started and start on YOUR questions!

Let’s review for a second…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.  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. But as of yet the  form is still required to be a snail mail submission. 

 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.  

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
Enter your personal information & Note: Do not enter information in the gray shaded areas
Please list the Provider/Organization name.
Note: Claimants must submit a separate form for each Provider where Medical Services were rendered.
•  List the description of charges
•  Enter the Date of Service (MM/DD/YYYY) range
•  Enter the Amount paid out of pocket by Claimant
• Select “YES” checkbox stating that
you have included Proof of Payment
•  Up to 8 visits and/or services can be listed on the form
•  Calculate the Total Amount Paid for all visits and fill in the box at the bottom
Form must be signed by claimant or a representative & A date is required and
must be on or after the last date of service listed on this form.
1. Proof of payment is required (This can be a cash receipt, cancelled check or credit card slip)
2. It is recommended (but not required) to have your provider complete a HCFA 1500 form. This form can be submitted along with your 915 to ensure your bill is coded correctly and you are reimbursed for the proper services.

Medical Reimbursement-Prescriptions Form
Enter your personal information & Note: Do not enter information in the gray shaded areas
Please list the Pharmacy name - Note: A separate form is required for each Pharmacy where medications were dispensed
•  List the National Drug Code #, the Quantity (how many ml/mg) and the days of supply under  “Description of Charge”
•  Enter the Date of Service (MM/DD/YYYY) when the prescription was filled
•  Enter the Amount Paid by Claimant
•  Select the “YES” checkbox stating that you have included proof of payment
•  Up to 8 visits and/or services can be listed on this form
•  Calculate the Total Amount Paid for all services and fill in the box at the bottom
Form must be signed by claimant or a representative & A date is required and
must be on or after the last date of service listed on 915.
Proof of payment is required : (This can be a cash receipt, pharmacy itemized statement, cancelled check or credit card slip).
2. Receipts and pharmacy itemized statements must be marked "patient paid" or "paid by patient" to  show who paid the charges
3. If pharmacy receipts have the NDC #, quantity and day of supply, the drug name can be listed on the 915 form.

Completing the OWCP 957A Travel Reimbursement form – Mileage
Enter the following information:
a. In field 7a, Enter the date or dates you traveled.
b. In field 7b, select your reason for travel.
c. In field 7c, select where you traveled from and to
d. In field 7d, enter the full name and address of the medical facility.
e. In field 7e, select if the trip was One-way or Round trip. Only select one box.
▪  One-way: Leaving to go to a destination without returning to the place you left.
▪  Round trip: Departing from your original location “A,” traveling to your destination “B,” and returning back to “A” (where you began).
f.  In field 7f, enter the total miles traveled for the trip.
Note: Sections cannot be partially completed. Use a new section for each Date of Service (DOS). The person claiming reimbursement must sign and enter the date. The date must be on or after the last date of travel.
Completing the OWCP 957B Travel Reimbursement Form - Expenses
9. Complete a separate block for each medical facility,
pharmacy, therapist, etc. visited.
a. In the Date field, enter the date of travel.
b. In the From field, enter the full street address of the
location where your trip began.
c. In the To field, enter the full street address of the location where your trip ended.
d. In the checkboxes to the right of From field, select the checkbox indicating whether the trip  was one-way or round trip.
Complete a separate block for each medical facility, pharmacy, therapist, etc. visited.
a. If you drove or were driven in a private car, in the Total miles traveled field, enter the number of miles here for mileage reimbursement.
Note: Claimants are reimbursed per mile and not based on a gas receipt. Ensure your miles include  only whole numbers and not decimals. (Example: If you traveled 9.2 miles, enter 9 miles.)
b. In the Other travel expenses field, select the applicable checkboxes and enter the dollar amount  spent in each category. Attach receipts for each item. If you use the “Other” checkbox, name the item in the line below the checkbox.
Note: If you use the “Other” checkbox, list the actual cost and specify the type of expense in the Specify “Other” expenses field.
Note: Sections cannot be partially completed. Use a new section for each Date of Service (DOS).
The person claiming reimbursement must sign and enter the date. The date must be on or after the last date of travel.
Original receipts are required for lodging, airfare, rental car, and any other expense that exceeds $75.
Claimant’s last name and OWCP Claim Number must be listed on submitted attachments. Be sure to keep a copy for your records.
Meals, lodging, and travel exceeding 100 miles roundtrip require prior authorization from the  District Office
Claimant Reimbursements can be submitted via mail to:
Division of Federal
1  Employees’
Compensation Act (FECA)
PO Box 8300 London, KY 40742-8300
Division of Energy
2  Employees Occupational Illness Compensation (DEEOIC)
PO Box 8304
London, KY 40742-8304
Division of Coal Mine
3  Workers’ Compensation
(DCMWC)
PO Box 8302
London, KY 40742-8302
Note: If your bill is not processed within 28 days, contact a Customer Service Specialist.
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

Also the there was a major announcement by OWCP in January of this year on impairment ratings changes. This is a major shift in the impairment rating rules and provisions. I am doing a deep dive on this and will cover it on the next podcast. Also there is a brand new Provider Manual that has been placed on the ‘DOL website covering all recent and relevant topics for all divisions of Fed COMP that I will be covering in the near future. So, your going to want to hit that subscribe button and keep up with these big new changes. 

Ok… I think that is enough for today…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 this is my 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!