Definition of a Physician under the FECA
“Physician” includes all Doctors of Medicine (M.D.), podiatrists, dentists, clinical psychologists, optometrists, chiropractors, or osteopathic practitioners within the scope of their practice as defined by State law.
The term “physician” includes chiropractors only to the extent that their reimbursable services under the FECDA are limited to manual manipulation of the spine to correct a subluxation (dislocation) as demonstrated by x-ray to exist.
A medical report that indicates the dates of treatment, diagnosis, findings, and type of treatment offered is required for services provided by a physician (as defined above).
For FECA claimants, the initial medical report should explain the relationship of the “causal connection,” on a “51/49” weighing of the facts of the injury event related to the diagnosis of the injury or illness.
Test results and x-ray findings should accompany billings.
Submit Medical Bills On Form OWCP-1500
MEDICAL BILLS SHOULD B SUBMITTED TO OWCP USING FORM OWCP-1500, WHICH, FOR ALL INTENTS AND PURPOSES, IS IDENTICAL TO THE FORM KNOWN AS “HCFA-1500”.
Care Providers Must Agree to OWCP’s Fee Schedule
Under the FECA, by submitting a bill to the OWCP, medical care providers agree to OWCP’s fee schedule, and cannot seek reimbursement from you for any amounts not paid by OWCP. The following is language from the Form OWCP-1500 requiring the medical care provider’s agreement to these terms.
SIGNATURE OF PHYSICIAN OR SUPPLIER: Your signature in Item 31 of Form OWCP-1500, indicates your agreement to accept the charge determination of OWCP on covered services as payment in full, and indicates your agreement not to seek reimbursement from the patient of any amounts not paid by OWCP for covered services as the result of the application of its fee schedule or related tests for reasonableness (appeals are allowed). Your signature in Item 31 also indicates that the services shown on this form were medically indicated and necessary for the health of the patient and were personally furnished by you or were furnished incident to your professional services by your employee under your immediate personal supervision, except as otherwise expressly permitted by FECA, Black Lung or EEOICPA regulations. For services to be considered as “incident” to a physician’s professional service, 1. they must be rendered under the physician’s immediate personal supervision by his/her employee,
2) they must be an integral, although incidental, part of a covered physician’s service,
3) they must be of kinds commonly furnished in physician’s offices, and
4) the services of non-physicians must be included on the bills.