Question OWCP

TJAlexander

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Has anyone been able to reach anyone at OWCP since they changed administrators? Every time I call I get a message saying due to call volume they are unable to take my call and I get disconnected. I never had this issue with Conduent. CNSI has been a nightmare.:mad: Approvals have stalled, claims aren't being processed, and although I have found some information on the portal its been like beating my head against a brick wall. I don't even know who to go to to try to get some resolution!
 

SharonCollachi

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I haven't had any problems, but then again, I haven't had to call them either. My claims are getting paid. My pre-auths are getting approved. I call my district office when I have a problem, leave a message for the adjustor, and they call me back.

What kind of problem are you having?
 

TJAlexander

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It's impossible to get anyone on the phone. We've been trying for weeks yet every time we call and go through all the prompts we're told, "Due to our large call volume, we are unable to accept your call", then the call disconnects. We've been waiting for approval to add an additional diagnosis code for one of our patients and we've been waiting weeks. The adjuster advised that we just have to wait due to the transition. Our regional office is in Florida.
 

mjh1027

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Has anyone been able to reach anyone at OWCP since they changed administrators? Every time I call I get a message saying due to call volume they are unable to take my call and I get disconnected. I never had this issue with Conduent. CNSI has been a nightmare.:mad: Approvals have stalled, claims aren't being processed, and although I have found some information on the portal its been like beating my head against a brick wall. I don't even know who to go to to try to get some resolution!

It's been a complete nightmare for me too. At first I had to wait over 4 hours to get someone on the phone!!!!!!! It was ridiculous. Now it's been better, but I still have claims from May that havent paid 😡 It feels like the agents don't know what they're talking about either. I had one of them tell me "99214 did not pay because it's a telemedicine code"......after that conversation, I realized that the new administrators are a disaster.
BTW I'm in florida too! Maybe it's just our district?????

Best of luck!
 

vshubert

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I have been able to reach them at 1-866-272-2682 and I have not had to wait long. However I am running into the same trouble mjh1027 mentioned they are saying that 99214 is not a telemedicine code. I am not sure what to do I came on here to see if anyone else was having trouble with OWCP claims and this was the very first post I saw at the top of the list. If anyone can help that would be great.
 

mjh1027

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It sounds like OWCP has not followed everyone else who is using regular codes for telemedicine. For OWCP, it the code is not in their computer, it won't get paid. Just like if the diagnosis is not assigned to your patient, your claim won't get paid. Have you tried using the actual telemedicine CPT codes?

US DOL OWCP Telemedicine for Routine Physician Appointments (click me).

I tried billing E/M with Mod 95 and EVERYTHING came back denied. Its been a real headache.
I do DFEC billing...they have yet to release a bulletin on telehealth.
 

mjh1027

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But did you bill the telemedicine E&M code, not the regular E&M code?

I have not. I may have misunderstood, but I think the telemedicine codes do not apply because this visits are done thru a patient portal. In our case, our providers are seeing patients thru Skype/Google meets.
Also HCPCS code G2012 is not payable by DOL for FECA patients.
 

SharonCollachi

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I have not. I may have misunderstood, but I think the telemedicine codes do not apply because this visits are done thru a patient portal. In our case, our providers are seeing patients thru Skype/Google meets.
Also HCPCS code G2012 is not payable by DOL for FECA patients.

That's what I'm saying... normally, telemedicine has its own codes. During the Pandemic, virtually all of the insurance companies have relaxed the rules and instructed that telemedicine visits should be billed using regular E&M codes.

However, OWCP did not do this. Look at the regular telemedicine CPT codes (not HCPCS codes). There are codes for electronic visits available in CPT.
 

mjh1027

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That's what I'm saying... normally, telemedicine has its own codes. During the Pandemic, virtually all of the insurance companies have relaxed the rules and instructed that telemedicine visits should be billed using regular E&M codes.

However, OWCP did not do this. Look at the regular telemedicine CPT codes (not HCPCS codes). There are codes for electronic visits available in CPT.


So how do I know when to use 99212-99215 and 99421-99423???
 

SharonCollachi

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99211-99215 is an office visit for E&M. You would only use those if the person is seen in the office.
99441-99443 are for phone calls
99421-99423 are for online E&M
 

mjh1027

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99211-99215 is an office visit for E&M. You would only use those if the person is seen in the office.
99441-99443 are for phone calls
99421-99423 are for online E&M


I thought that because of the pandemic we were able to use 99212-99215 with Mod 95......which brings me to another problem I've been facing. This new payor is denying all claims that have a mod 95
 

vshubert

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I thought we are able to bill as if the visit was face to face with the 99212-99215 and add the modifier 95. I know at first CMS instructed to change POS to 02 and then they later came back and said to leave POS 11. Due to payment for POS 02 is less than payment for POS 11. I spoke with someone the first time I got the denials for all telehealth claims and they said to change POS and resubmit. So that is what I did and then they denied all of them again. And when I talked to a representative they just repeat what is on the remit and say all I know is what it says on the remit. It is very frustrating.

On the website, I did locate a document titled "Temporary Guidance on Telehealth" and inside the document, there is a section called "How does the provider bill the payer?" and it states:

"The providers may bill using the standard appropriate billing forms in accordance with CMS guidance. The applicable codes for CPT recognized procedures are available at https://www.ama-assn.org/system/files/2020-03/cpt-reporting-covid-19-testing.pdf. Further information specifically for physicians may be found at https://www.ama-assn.org/system/files/2020-03/covid-19-coding-advice.pdf. A Modifier should be added to the appropriate CPT code and a location code. Since these have not been standardized by different insurers, check the CMS website for guidance for each particular type of communication."

Sorry, so long I am not able to scan in documents.
 
Last edited:

SharonCollachi

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I thought we are able to bill as if the visit was face to face with the 99212-99215 and add the modifier 95. I know at first CMS instructed to change POS to 02 and then they later came back and said to leave POS 11. Due to payment for POS 02 is less than payment for POS 11. I spoke with someone the first time I got the denials for all telehealth claims and they said to change POS and resubmit. So that is what I did and then they denied all of them again. And when I talked to a representative they just repeat what is on the remit and say all I know is what it says on the remit. It is very frustrating.

On the website, I did locate a document titled "Temporary Guidance on Telehealth" and inside the document, there is a section called "How does the provider bill the payer?" and it states:

"The providers may bill using the standard appropriate billing forms in accordance with CMS guidance. The applicable codes for CPT recognized procedures are available at https://www.ama-assn.org/system/files/2020-03/cpt-reporting-covid-19-testing.pdf. Further information specifically for physicians may be found at https://www.ama-assn.org/system/files/2020-03/covid-19-coding-advice.pdf. A Modifier should be added to the appropriate CPT code and a location code. Since these have not been standardized by different insurers, check the CMS website for guidance for each particular type of communication."

Sorry, so long I am not able to scan in documents.

This is not CMS or any other type of health insurance, so what they are doing doesn't apply here. This is DOL OWCP, Office of Workers Compensation, for Federal Workers who have been injured on the job, aka, Federal Work Comp. As I stated above, there is guidance and it does NOT say to do what everyone else is doing. If you are doing what everyone else is doing and it is denying, then the next logical step is to bill it as regular telehealth.
 

mjh1027

Networker
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Land O Lakes, FL
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I thought we are able to bill as if the visit was face to face with the 99212-99215 and add the modifier 95. I know at first CMS instructed to change POS to 02 and then they later came back and said to leave POS 11. Due to payment for POS 02 is less than payment for POS 11. I spoke with someone the first time I got the denials for all telehealth claims and they said to change POS and resubmit. So that is what I did and then they denied all of them again. And when I talked to a representative they just repeat what is on the remit and say all I know is what it says on the remit. It is very frustrating.

On the website, I did locate a document titled "Temporary Guidance on Telehealth" and inside the document, there is a section called "How does the provider bill the payer?" and it states:

"The providers may bill using the standard appropriate billing forms in accordance with CMS guidance. The applicable codes for CPT recognized procedures are available at https://www.ama-assn.org/system/files/2020-03/cpt-reporting-covid-19-testing.pdf. Further information specifically for physicians may be found at https://www.ama-assn.org/system/files/2020-03/covid-19-coding-advice.pdf. A Modifier should be added to the appropriate CPT code and a location code. Since these have not been standardized by different insurers, check the CMS website for guidance for each particular type of communication."

Sorry, so long I am not able to scan in documents.



That is exactly why working with OWCP has been so frustrating during this pandemic. I understand the need to attach MOD 95 and POS11. However, after submitting claims using the modifier, they ALL came back denied. After speaking with an agent from CNSI, she told me that a modifier was not required. Basically she told me that we did not need to bill as if it were a telehealth visit. It's all so confusing 😭
 

vshubert

Contributor
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Loudon, TN
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I know it is DOL. And I have the same frustration as everyone it seems. And I have been doing medical billing for a little over a year so I know I am still learning.
 

SharonCollachi

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Basically she told me that we did not need to bill as if it were a telehealth visit. It's all so confusing 😭

Then bill it exactly as an office visit, as if the person was there in your office, and make a record of who you talked to and when, and photocopy that and put it in every chart after every visit (or attach it into your EMR), to CYA, so that if you're ever audited, you have the reason in writing why it was done that way.
 

mjh1027

Networker
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Land O Lakes, FL
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This is not CMS or any other type of health insurance, so what they are doing doesn't apply here. This is DOL OWCP, Office of Workers Compensation, for Federal Workers who have been injured on the job, aka, Federal Work Comp. As I stated above, there is guidance and it does NOT say to do what everyone else is doing. If you are doing what everyone else is doing and it is denying, then the next logical step is to bill it as regular telehealth.


To my understanding, I am billing as a regular telehealth: 99213 with MOD 95 and POS 11

CPT code 99421-99423 does not fit the description for the visits done here.
 

TJAlexander

Networker
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48
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I've had denials using modifier 95 with E/M codes so I removed the modifier and just used place of service 02. Then I was told that the W/C note needs to specifically indicate the manner used for the telehealth visit. I swear you'll get a different answer depending on who answers the phone.
 

cleanclaims

Networker
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Manchester, TN
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We get them paid, but very rarely. I think it is just the luck of the draw on which person processes your claim though. The majority of ours deny "90931-DISTANT SITE AND ORIGINATING SITE NOT IN THE SAME STATE" or "60915 THE PROCEDURE CODE BILLED FOR TELEHEALTH MUST BE ON THE LIST OF PROCEDURE CODES APPROVED FOR TELEHEALTH". I have 6 claims billed exactly the same way as my denied claims and they paid but the others didn't. I have looked for the "list of procedure codes approved for telehealth" but have never found said list. If anyone else is able to find it, I would love to use it for appeals. When we do get paid it is with place of service 02, no modifiers, and codes such as 99443. I attached a de-identified copy of an EOB showing payment.
 

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