Training Resources
Training Resources
We have to fully understand DOL and the needs of the various players in the DOL system. From time-to-time, we will deal with and have to understand the needs of all of the following:
a. They want a doctor who can get their injury claim accepted and help them get paid.
b. They want a doctor who understands their special forms and knows how to use them.
c. They don’t want to use their personal health insurance, which is expensive and costs them their federal work injury benefits that are a right given to them by the federal government.
d. They want their doctor to be able to provide all related services needed so they don’t have to go to multiple doctors.
e. They want their doctor to be able to do schedule award impairment ratings.
f. They want to be treated like VIP’s with top-quality care, speedy wait times and friendly staff.
a. They want a doctor who can help their union members with everything related to their federal work injury. The doctor should understand causation, DOL forms, schedule award impairment ratings, etc.
b. They want a doctor who will treat the injury even before the claim is accepted, and who knows how to get the claim accepted.
c. They want a doctor who will reduce their own personal work load related to work injury claims and grievances associated with those claims.
d. They want a doctor who “speaks the language” in Department of Labor workers comp.
e. They want to know that a doctor follows the law. Many union leaders have been burned by non-compliant, illegal actions of people trying to profit from their members.
f. Many union leaders will appreciate it when a doctor’s office will participate with them in public service events such as food drives, toy drives, etc.
a. They want clean claims that are based on medical necessity.
b. They want extraordinary, detailed narrative reports with strong causation.
c. They want patients to go back to work full duty.
a. They want a doctor who can help their client with federal work injuries.
b. They want a doctor who knows how to help clients with OPM Disability Exams.
c. They like referrals from doctors who have patients with serious problems that can’t be solved by the doctor.
d. They want a doctor who can do Schedule Award Impairment Ratings.
a. They want doctors to follow all of the rules and maintain the highest level of ethics and compliance.
b. They also want doctors to be sure they are only treating patients who have legitimate work-related injuries and that treatment is not excessive and is based on medical necessity.
1. We file on DOL instead on their personal health insurance. This saves them money and preserves their lifetime federal work injury benefits.
2. We are not the “company doctor”. We will always do what is in the best interest of the patients first. While we will never do anything unethical or illegal, we will never be pressured to do something that is not in the patient’s best interest.
3. By filing on DOL, we can help them get paid for time off of work and for travel to and from medical care.
4. We help them with their symptoms with more than just pain pills. We can help patients in a variety of other ways, including: physical therapy, chiropractic, non-medication pain alternatives such as Tens Units, Back and Knee Braces, Massage, and more as indicated for each injury.
5. We work closely with their Union Leaders to help them with the problems they otherwise deal with daily to help their injured members.
6. Patients have the time to focus on getting better and stronger so they can get back to work without getting reinjured.
What are our Unique Selling Points that are of Importance to DOL patients and their Union Leaders?
1. We have Medical Doctors who know how to get their injury claim accepted by the DOL.
2. We know how to show causation and how to write excellent reports that get claims accepted.
3. We will begin treatment even if an injury claim has not been accepted yet. We will never wait for claim acceptance to begin treating injured federal employees.
4. We understand the various forms required by DOL and we can help injured federal employees get paid when they are hurt at work.
5. We know how to handle CA17 Duty Status Reports to take employees off work as needed or used restricted duty when a patient can still work at some level.
6. We treat patients with physical therapy in our offices. We will strengthen injured workers so that they can go back to work without getting reinjured.
7. We are associated with an imaging facility that will do imaging such as MRI’s even when a case has not been accepted yet.
8. At all times, we will treat patients based on what is medically necessary and indicated for the accepted conditions. Our documentation and billing will always be valid and based on actual medically indicated treatment.
9. We can alleviate work from union leaders who are dealing with work injury problems of their union members.
10. We can help patients with Schedule Award Impairment Ratings using the 6th Edition Guide to Permanent Impairment.
The OWCP governs everything related to federal workers compensation. When advertising, we should be aware that OWCP is a common term understood by our federal employee patients. This is the office in Department of Labor that handles federal workers comp.
The DOL is the Federal Agency that governs OWCP. DOL pays for all work injury related services.
Federal Employees Compensation Act. FECA is the law that governs federal workers comp.
Office of Inspector General. This is the agency that investigates fraud and other illegal activity in the federal government, especially related to healthcare. We will never break the law requiring the OIG to focus their time and resources on us.
CA1 – This form is used to file a work injury that happened as a result of a traumatic event such as bending over and lifting a heavy box.
CA2 – This form is used to file a work injury that occurred over a longer period of time (days, weeks, months or years). These are repetitive injuries such as Tendinitis and Carpal Tunnel Syndrome that develop over time.
CA7 – Claim for Compensation. This form is filled out by the patient and their employing agency so they can be paid after they are hurt at work. For CA1 claims, the CA7 is used after the 45-day Continuation of Pay (COP) period has ended.
CA16 – Authorization for Examination and/or Treatment. This form is used by patients to pay for healthcare costs related to work injuries. It’s only available for CA1 claims that were reported within 7 days of the injury.
CA17 – Duty Status Report. This form is used when taking patients off work or when ordering restricted / light duty. The supervisor fills out side A and the physician fills out side B. Ideally, this form should originate with the supervisor.
CA20 – Attending Physician’s Report. This form may be used in addition to a complete narrative report. It is also needed as supporting documentation by patients who are submitting CA7’s for payment.
Functional Capacity Evaluation (FCE) testing. FCE testing measures:
• Bending• Squatting• Stooping• Reaching• Lifting• Grip Strength• Cardiovascular Ability• And other physical abilities.
These tests should also be done in more frequent intervals in the form of Physical Performance Evaluations. These are “mini” FCE’s that measure periodic progress in physical / functional ability as it relates to each individual’s work requirements. Federal employees want to go back to work full duty. Functional testing is the “science” behind return-to-work.
1. The MD must see and evaluate everything new patient and either write, or review, edit, professionally agree with, and sign every narrative report.
2. The MD directs all treatment in DOL. The MD must prescribe and sign for all physical therapy, DME, and all other treatments.
3. The Chiropractor can perform all physical therapy as prescribed by the MD.
4. All active therapy, exercises and activities, must be done with constant 1-on-1 attendance by the Chiropractor, Physical Therapist, or Licensed Physical Therapy Assistant.
5. All treatment done within 120 days of the date-of-injury can be done without preauthorization. All treatment done after 120 days requires preauthorization.
6. Generally, all treatment that is medically indicated for an accepted condition will be approved.
7. Patients are allowed to attend doctor’s visits and therapy appointments for up to 4 hours of their scheduled work shifts.
8. We will never prescribe any treatment that is not medically indicated and that is not expected to help the patient get better and back to work, and we will never bill or document for anything that is not actually provided to the patient.
Successful practices in DOL focus their resources on marketing. Our business runs at the speed of marketing. Marketing ranks among our highest business priorities, behind Compliance, Patient Care, and Patient Satisfaction. Our marketing plan will have many legs. These will include, but may not be limited to:
1. Relationships with Union Leaders.2. Attendance to Union Meetings and Training Classes.3. Internet Marketing, including having a Strong Web Presence.4. Direct Mail Campaigns.5. Email Blasts.6. Large, Visible External Signage.7. Brochures in the Office.8. Brochures in the Break Rooms of our Patient’s Work Places.9. Extraordinary Customer Service and Asking Patients for Referrals.10. Referral Relationships with DOL Attorneys.11. Referral Relationships with Outside Doctors and Hospitals.12. Most Importantly: Constant, Face-to-Face Marketing (Relationship Building) with Everyone Related to the DOL Patient.13. NEVER PAY FOR REFERRALS. Patient Brokering, Kickbacks, and other fraudulent marketing activities are illegal and are forbidden at Federal Injury Centers. Patients will come to our offices based on their knowledge of us and from their own personal choice of physician. Their choice of physician is their right and we honor that.
NALC – National Association of Letter Carriershttps://www.nalc.org/These are the city letter carriers at the USPS.
APWU – American Postal Workers Unionhttp://www.apwu.org/These are clerks and maintenance staff at the USPS.
NRLCA – National Rural Carrier Associationhttp://www.nrlca.orgThese are rural letter carriers at the USPS.
NPMHU – National Post Mail Handlers Unionhttp://www.npmhu.orgThese are mail handlers at the USPS.
AFGE – American Federation of Government Employeeshttp://www.afge.org/These federal employees work at a variety of agencies, including: VA Hospitals, TSA, Defense Bases, Prisons, Social Security, and several other federal agencies.
NAGE – National Association of Government Employeeshttp://www.nage.orgThese federal employees work at a variety of agencies.
National Border Patrol Councilhttp://www.bpunion.orgThese are employees of the border patrol.
LWOP – Leave Without Pay. When patients take off work (after an accepted claim), they need a way to be paid when they’re off the clock. So, they select LWOP on their CA7 forms. This indicates they were away from work due to a work injury and they need to be paid for that time.
COP – Continuation of Pay. Patients with CA1 conditions that were reported within 30 days of the injury are eligible for up to 45 calendar days of pay (not consecutive days). These 45 days are called COP. COP lasts 45 calendar days or until the claim is approved, whichever comes first.
§10.310 What are the basic rules for obtaining medical care?
(a) The employee is entitled to receive all medical services, appliances or supplies which a qualified physician prescribes or recommends and which OWCP considers necessary to treat the work-related injury. Billing for these services is described in subpart I of this part. The employee need not be disabled to receive such treatment. If there is any doubt as to whether a specific service, appliance or supply is necessary to treat the work-related injury, the employee should consult OWCP prior to obtaining it through the automated authorization process described in §10.800. OWCP may also utilize the services of a field nurse to facilitate and coordinate medical care for the employee. OWCP may contract with a specific provider or providers to supply such services or appliances, including durable medical equipment and prescribed medications.
(b) Any qualified physician or qualified hospital may provide such services, appliances and supplies. Non-physician providers such as physicians’ assistants, nurse practitioners and physical therapists may also provide authorized services for injured employees to the extent allowed by applicable Federal and State law.
(c) Where OWCP has not contracted for the provision of appliances or supplies, only a supplier of durable medical equipment that is registered in Medicare’s Durable Medical Equipment, Prosthetics, Orthotics and Supplies Accreditation process may furnish such appliances and supplies. OWCP may apply a test of cost-effectiveness to appliances and supplies, may offset the cost of prior rental payments against a future purchase price, and may provide refurbished appliances where appropriate.
§10.311 What are the special rules for the services of chiropractors?
(a) The services of chiropractors that may be reimbursed are limited by the FECA to treatment to correct a spinal subluxation. The costs of physical and related laboratory tests performed by or required by a chiropractor to diagnose such a subluxation are also payable.
(b) In accordance with 5 U.S.C. 8101(3), a diagnosis of spinal “subluxation as demonstrated by X-ray to exist” must appear in the chiropractor’s report before OWCP can consider payment of a chiropractor’s bill.
(c) A chiropractor may interpret his or her x-rays to the same extent as any other physician. To be given any weight, the medical report must state that x-rays support the finding of spinal subluxation. OWCP will not necessarily require submittal of the x-ray, or a report of the x-ray, but the report must be available for submittal on request.
(d) A chiropractor may also provide services in the nature of physical therapy under the direction of, and as prescribed by, a qualified physician.
§10.315 Will OWCP pay 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.
(c) If a claimant disagrees with the decision of OWCP that requested travel expenses are either not reasonable or necessary, or are not incident to obtaining authorized medical services or supplies, he or she may utilize the appeals process described in subpart G of this part.
(d) The standard form designated for medical travel refund requests is Form OWCP-957 and must be used to seek reimbursement under this section. This form can be obtained from OWCP.
§10.316 After selecting a treating physician, may an employee choose to be treated by another physician instead?
(a) When the physician originally selected to provide treatment for a work-related injury refers the employee to a specialist for further medical care, the employee need not consult OWCP for approval. In all other instances, however, the employee must submit a written request to OWCP with his or her reasons for desiring a change of physician.
(b) OWCP will approve the request if it determines that the reasons submitted are sufficient. Requests that are often approved include those for transfer of care from a general practitioner to a physician who specializes in treating conditions like the work-related one, or the need for a new physician when an employee has moved. The employer may not authorize a change of physicians.