ACS-DOL Bill Automated Adjustments Process for FECA Providers 2010 Systematic Recoupment of overpayment

Table of Contents What is the new process? p. 3 How will the change affect me as a provider? p. 4 How do I complete the template? p. 5 What is considered an adjustment request? p.10 How do I request an adjustment? p.12 How do I submit an adjustment request? p.14 When can I expect a response after submitting a request? p.15 What if I don’t know the status after 10 business days? p.17 Systematic Recoupment of Overpayments p.19 Payment p.26 Refund p.30 What if I have not received payment? p.31 Return to Provider (RTP) p.32 Appendix A: Definitions p.36 Appendix B: FAQ page for easy access and printing p.37 Appendix C: Helpful Links p.38

What is the new process? The new process requires the use of an adjustment template to more readily identify adjustment requests The new process allows for the automatic recovery of overpayments from weekly payments. The automated adjustments process will provide: Faster, more efficient processing Systematic notification of credit balance owed to DOL Automated adjustment processing upon receipt of request

How will the change affect me as a provider? The new automated adjustments process will only affect OWCP FECA Providers As a FECA provider, when a bill is submitted requesting adjustment processing, the provider will make the request using the new adjustment template

How do I complete the template? Box 1 – Enter the 17 digit TCN of the bill to be adjusted Box 2 – Enter the 9 digit claimant ID number and the claimant’s name Box 3 – Enter the provider name, address, 9 digit ACS Provider ID number, phone number, and name of a contact person Box 4 – Check the reason for adjustment Box 5 – Enter the explanation for adjustment Provider signature and date is required for processing VOICEOVER: To request a bill adjustment, please enter the following information: In box 1 Enter the TCN of the bill to be adjusted In box 2 Enter the claimant’s 9 digit OWCP case number and the claimant's name In box 3 Enter the provider name, address, 9 digit ACS Provider number, phone number, and contact name Box 4 is for internal ACS use only. In box 5 please enter the explanation for adjustment Finally, be sure to sign and date the request

How do I complete the template? Complete all fields on the template If information is missing or invalid, the request may be returned to provider (RTP’d). To ensure correct processing, please complete one template for each bill to be adjusted Do not add multiple case numbers or TCNs to one document. Each request is matched to an original TCN to ensure accuracy. You may indicate “See Attached” in the “Explanation of Adjustments” field

Supporting Documentation Supporting documentation is required Adjustment requests must be submitted with a corrected bill (preferred) or an RV indicating TCN to be adjusted Bill should include verbiage such as “corrected bill,” “reconsideration,” or “adjustment” If submitting an RV, please note that only the TCN included on the template will be adjusted with each request Note: if a bill is submitted with Corrected Claim verbiage without the adjustment template, the bill will be processed as a new day bill, not as an adjustment request.

Supporting Documentation Submit additional documentation as necessary E.g. manufacturer’s invoice for implants or supplies, operative reports, and/or admission and discharge summaries, etc., to support justification for applicable procedures/services billed.

What is considered an adjustment request? An adjustment request is a correction, change or update to a bill. Adjustment request can occur for the following examples : Payment consideration for a partially paid bill Payment consideration for a previously denied bill General corrections to a previously submitted bill (ex. CPT Code changes, incorrect case number) An Authorization is now on file

What is considered an adjustment request (continued)? Timely filing along with proof of timely filing Claimant eligibility or treatment suite issues Requesting reprocessing for duplicate denials Submittal of additional documentation Implants payment- along with proof of purchase and/or manufacturer’s invoice

What’s the difference between an appeal vs. an adjustment? An adjustment is a request to correct, change or update previously billed information. An appeal is a request to review and re-consider the amount paid per the OWCP fee schedule, based on the following criteria: The billed amount is based on the complexity of the service/procedure performed The presence of a severe medical condition made treatment especially difficult The provider possesses unusual qualifications (i.e. additional qualifications beyond Board certification in a medical specialty, such as professional rank or published articles) If you would like to submit an appeal, please submit: the bill with the word “Appeal” clearly indicated the written reason for requesting a review of the amount paid Note: an adjustment template is NOT required for an appeal

How do I request an adjustment? FECA providers must request adjustment using the appropriate template This template does not apply: Pharmacies (submitting transactions via POS or Tape transmissions) DOL-contracted providers (Contract Nurses, Voc Rehab, and SECOP Providers) Providers for the DEEOIC (Energy) Program Providers for the DCMWC (Black Lung) Program To obtain and/or retrieve the adjustment template: Download the FECA Adjustments request template from the ACS-DOL Web Portal http://owcp.dol.acs-inc.com/portal/formsAndLinks.do Adjustment requests coming directly through the ACS-DOL Call Center (844) 493-1966 will be redirected to utilize the web site with the exception of an adjustment request due to authorization now on file If you cannot download the template from the Web Portal, please call our call center and request a document to be faxed to you. DOL Welcome Packets for newly enrolled providers will also include copies of the template

How do I submit an adjustment request? Mail the template along with your corrected bill and/or other attachment (s) to : DFEC Mailroom P.O. Box 8300 London, KY 40742-8300

When can I expect a response after submitting a request? Adjustment request submitted by providers are sent to London KY. Once received, providers can/will: Receive bill payment status within 10-business days from date of receipt. Receive an RTP (return to provider for additional information ) letter within 10-business days from date of receipt in London, Kentucky mailroom. Have the ability to check bill status on the Web http://owcp.dol.acs-inc.com or ACS IVR 1-866-335-8319 You can call the ACS Call Center at (844) 493-1966 Monday - Friday 8 a.m. to 8 p.m. EST for any additional information or assistance

When can I expect a response after submitting a request (continued)? Web http://owcp.dol.acs-inc.com To check your bill status online, you must have a user ID and password to access the secure portal. If you do not have an account, please register as a user by clicking here. IVR (Interactive Voice Response) 24/7 access 1-866-335-8319 Review the Remittance Voucher (RV) online Select Payment Status page on the Web Portal inquiry menu 123123 321321 231231

What if I don’t receive a response after 10 business days? Call the ACS/IVR system at 1-866-335-8319 Check bill status on the Web Portal Call the ACS Call Center at (844) 493-1966 Monday - Friday 8 a.m. to 8 p.m. EST

Systematic recoupment of overpayments

Systematic recoupment of overpayments Automated Adjustment Process allows for systematic recoupment of overpayments. The automatic recoupment of an overpayment occurs when a provider has been over paid for a service. What creates an overpayment? An adjustment transaction that pays less than the original bill payment Example: Provider changes re-billed units and/or billed amount to be less the units or the total amount originally submitted A denial for a service that was previously paid Example: Provider changes the billed CPT that previously paid. The new CPT requires authorization and denies. The overpayment will create a credit balance on file and a debt to DOL

How do I know if I have a debt owed to DOL? Notification of over payments will post to your RV for the amount payable to DOL for each bill affected Review your RV for a total amount payable to DOL for each District Office Look for the field labeled “Ending Credit Balance Payable to Dept. of Labor”

Overpayment RV – Outstanding balance on RV “Ending Credit Balance Payable to Dept. of Labor” Overpayment created from this TCN Total amount now owed to DOL Total amount paid due to other bills paid

Overpayment info – Outstanding balance on Web Portal 40903112345678901 1234567 Amount Owed: Overpayment created

How is the money recouped? If a provider has a credit balance with OWCP, the amount will be automatically recouped from future bills submitted for the same provider AND same claimant If you send a refund to DOL, please ensure to repay the full overpayment amount from the originally submitted bill Partial repayments will not prompt an adjustment

Recoupment info on RV – debt satisfied Payable amount Payable amount of $106.30 is applied to two previous overpayment TCNS on file for the claimant Beginning total amount owed to DOL Amount recouped from this pay cycle Remaining total amount owed Amount remitted after recoupment and debt satisfaction for that claimant

Recoupment info on Web Portal 40932112345678901 Payable amount of $106.30 is applied to two previous overpayment TCNS on file for the claimant 4093211234567908 60932130300300033 Payable amount

How can I owe a debt to DOL yet still receive payment? The FECA Program assigns a credit balance based on the claimant for which services were performed. Future recoupments will occur on bills submitted for services rendered to that particular claimant. If you treat other DOL FECA claimants without a debt on file for their bills, you will receive payment for those services.

Recoupment info on RV – monies credited and debt remaining Overpayment on file for claimant Payable amount is applied to previous overpayment TCN (s) on file for the claimant Amount recouped and credited to overpayment Remaining amount owed to DOL for this claimant Remaining total amount owed to DOL

If I bill for multiple claimants, how do I tell which case has the overpayment on file? Credit balance summary page on your RV will show each claimant ID along with TCN, date the balance was created, and balance amount

Payment An adjustment transaction may pay additional monies to you if: Previously submitted charges for a procedure denied due to claimant eligibility edits Claimant case is now open and payable. Bill has been resubmitted for payment. The RV will show the credit (negative) and debit (positive) The RV will state “Net amount payable to you” “Net amount payable to you” - Only appears for positive adjustments –

Payment – Bill inquiry on Web portal 00932110200100100 987654 00912330305555530 00932110200200100 00932110200200100 987654

Refund An adjustment transaction that shows too much money was recouped from the provider. The RV will state “Net amount refunded to you” CLAIMANT NAME 121234567 0-09321-20-200-5555-55

What if I have not received payment? If it has been less than 45 days from date of payment, please allow the designated timeframe to occur before requesting assistance If it has been more than 45 days from the date of payment, please call the ACS Call Center at (844) 493-1966 and request a check trace.

Return to Providers (RTP) process

Request RTP reasons If request for an adjustment is incomplete the request will be returned for additional information. Reasons for RTPs can include: A TCN must be correct and on file for adjustment processing If it is not, the request will be RTP’d for “TCN not found, not valid, or not legible.” A requested adjustment or resubmitted bill that has been requested in the last 10 business days, (please allow 10 business days from date of receipt to pass before additional submissions) The request may be RTP’d for “TCN is currently being adjusted and in process” If a request is submitted more than three (3) times, the adjustment request will be reviewed manually

Return to Provider RTP reasons (continued) The claimant’s nine (9) digit case number and claimant name are required fields. Your nine (9) digit ACS Provider number, name, and address are required fields. If you do not know the case number or your provider number, please call the ACS call center at (844) 493-1966 Monday -Friday 8 a.m. to 8 p.m. EST for assistance

Return to Provider RTP Reasons (continued) An explanation of adjustment reason is required You may submit the verbiage “see attached.” A corrected bill is required for processing An RV indicating TCN to be adjusted may also be accepted

Appendix A: Definitions RV = Remittance Voucher or the explanation of benefits Adjustment = a request for reprocessing of a previously processed bill Appeal = a request for reconsideration of a payment calculated through the fee schedule Credit balance = amount owed to DOL due to an overpayment for services previously billed (also called: a debt, or an outstanding balance) Credit = a reversal or void of a previous processed bill Debit = a bill that remits monies to the submitter

Appendix B: FAQ Page Click the link below for a 1 page overview FAQ Document for Providers

Appendix C: Helpful Links ACS-DOL Web Portal Home Page http://owcp.dol.acs-inc.com ACS-DOL adjustments request template http://owcp.dol.acs-inc.com/portal/formsAndLinks.do ACS-DOL Web Portal registration page https://owcp.dol.acs-inc.com/sso/registration/providerAccount.do