David Testone – Learn to Bill the Department of Labor Using the Proper Fee Schedule

On April 27, 2020 the U.S. Department of Labor changed the administrator of its Workers’ Compensation Program from Conduent to CNSI. Legacy providers were sent a Welcome Letter and a Security Letter from CNSI in order to register on CNSI’s new website. Besides the usual trepidation chiropractors experienced dealing with the Federal Government, another bureaucratic requirement was presented. These “obstacles” should not prevent chiropractors from treating patients with Federal Workers’ Compensation claims; in fact, if the proper billing protocol is followed, chiropractors should enthusiastically welcome those patients. 

Key Teaching Points 

When a patient arrives at a chiropractor’s office after being injured while in the employ of the U.S. Government, that patient must be asked if he or she has formerly reported the incident to his or her supervisor. The reporting of the incident will generate a case file number assigned to the patient. The patient will then receive a formal letter from the Department of Labor with the assigned case number and the date of injury, the Department of Labor recognizes. The chiropractor must see the letter mentioned above before treating the patient so that the chiropractor can ascertain from the Department of Labor the approved diagnosis (es) and procedure code(s) for the case. Without this information, bill submissions will, in all probability, result in denials. 

Once the approved diagnosis(es) and procedure code(s) are obtained, the chiropractor must be sure to check which procedure code(s) require pre-authorization. In most cases, the pre- authorization for a procedure code requires a script from the treating physician. After the script is received, the chiropractor must submit the script for treatment along with the number of units and number of days required to the Department of Labor. 

After the authorization for treatment is approved and received, the chiropractor must be sure to utilize the appropriate fee schedule in order to receive the maximum allowable payment. The Department of Labor’s fee schedule is different from the Medicare fee schedule and Medi- Cal’s fee schedule. For example, an office visit in L.A. County is billed at $91.48 per the Medicare fee schedule, whereas that same office visit in L.A. County for a Federal Workers’ Compensation patient is billed at $109.84. 

Besides allowing new bill submissions for a period of up to one calendar year instead of one fiscal year as required by Medicare, chiropractors can adjust previously submitted bills for a period of up to seven years. Adjustments to bills may be a result of keying errors or applying the wrong fee schedule. 

In conclusion, the submission of bills to the U.S. Department of Labor for patients with Federal Workers’ Compensation claims must strictly follow the unique billing protocol established by the U.S. Department of Labor to ensure receipt of the maximum allowable payment for a procedure.

Presented by: FECA Billing