Matt Kilton, COO of Eveia Health Consulting & Management: The Department of Labor is a Federal program that provides, among other things, medical coverage for injured federal workers and their dependents.
The following are excerpts from its Web site (www.dol.gov/esa/owcp/dfec):
The Department of Labor’s Office of Workers’ Compensation Programs (OWCP) administers four major disability compensation programs which provide wage replacement benefits, medical treatment, vocational rehabilitation, and other benefits to federal workers or their dependents who are injured at work or acquire an occupational disease.
The most common is the Division of Federal Employees’ Compensation (DFEC) The Federal Employees’ Compensation Act provides workers’ compensation coverage to three million federal and postal workers around the world for employment-related injuries and occupational diseases.
OWCP Payment policies for Ambulatory Surgery Centers should be evaluated in detail to understand how this program works. Further information on how services are reimbursed can be found at www.dol.gov/esa/owcp/regs/feeschedule/fee/fee08/fs08ASCPaymentPolicy.doc.
All procedures covered by OWCP in an ASC are listed in the list of surgical procedures allowable for facility fee payment to ASCs available online at www.dol.gov/esa/owcp/regs/feeschedule/fee.htm.
Since your microdiscectomy codes are being denied because "per Medicare’s standards, this is not considered a procedure that Medicare approves payment on in a medical facility such as an ASC," this tells us that the Department of Labor ASC fee schedule follows Medicare’s list of approved ASC codes. Given that the Department of Labor is a Federal Workers’ Compensation Program, and not a state program, these rules apply to any injured worker covered by the Department of Labor. Many state worker compensation programs have added spine surgery to their list of ASC-approved codes (although not all, so check with your specific state). As a result it is more common at the state level to receive compensation for a microdiscectomy. However, until the Department of Labor adopts changes to its policy concerning spine surgery, I would suggest seeking prior written approval or not performing spine cases on patients covered by this particular insurance..
Mr. Kilton (mattk@eveia.com) is a member and the COO of Eveia Health Consulting & Management, a company comprised of a team of seasoned professionals who are experts in reimbursement management, managed care contracting, and business management with a specialization in ASCs and surgical practices. Learn more about Eveia.
