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ACS-DOLBill Automated

Adjustments Processfor FECA Providers

2010

Systematic Recoupment of overpayment

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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

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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

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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

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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

How do I complete the template?

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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

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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.

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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.

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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

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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

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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

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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

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How do I submit an adjustment request?

Mail the template along with your corrected bill and/or other attachment (s) to :

DFEC MailroomP.O. Box 8300

London, KY 40742-8300

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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

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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

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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

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Systematic recoupment of overpayments

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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

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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”

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Overpayment RV – Outstanding balance on RV

“Ending Credit Balance Payable to Dept. of Labor”

Overpayment created from this TCN

Total amount now owed to DOLTotal

amount paid due to other

bills paid

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Overpayment info – Outstanding balance on Web Portal

40903112345678901

1234567

Amount Owed:Overpayment created

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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

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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

Amount remitted after recoupment

and debt satisfaction for that claimant

Beginning total amount owed to DOL

Amount recouped from this pay cycle Remaining total amount owed

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Recoupment info on Web Portal

40932112345678901

4093211234567908

60932130300300033

Payable amount

Payable amount of $106.30 is applied to

two previous overpayment TCNS on file

for the claimant

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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.

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Recoupment info on RV – monies credited and debt remaining

Overpayment on file for claimant

Amount recouped and credited to overpayment

Remaining amount owed to DOL for this claimant

Remaining total amount owed to DOL

Payable amount is applied to previous

overpayment TCN (s) on file for the claimant

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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

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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 –

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Payment – Bill inquiry on Web portal

987654

00932110200100100

00932110200200100

987654

00912330305555530

00932110200200100

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Refund

An adjustment transaction that shows too much money was recouped from the provider.

The RV will state “Net amount refunded to you”

CLAIMANT NAME121234567 0-09321-20-200-5555-55

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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.

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Return to Providers (RTP) process

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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

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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

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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

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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

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Appendix B: FAQ Page

Click the link below for a 1 page overview FAQ Document for Providers

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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