Complying with New Regulations on Federal Employee Workers’ Comp Claims for Opioid Medications

Posted by admin | November 30, 2017 , (0) comments

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In light of the growing epidemic of opioid addiction and overdose in the United States, the Division of Federal Employees’ Compensation (DFEC) within the Office of Workers’ Compensation Programs (OWCP) has issued new guidelines for workers’ compensation claims for opioid medications for federal employees. While the OWCP DFEC acknowledges that opioid medications are valuable for some injured workers, the Federal Employees Compensation Act (FECA) program believes that safety concerns justify more stringent standards.

The new workers’ compensation policy is being administered in two phases. The first phase went into effect in August 2017. Now, in order for workers’ compensation claims for new opioid prescriptions for federal employees to be processed, stricter standards must be met. Read on to learn more about the first phase of the new policy.

Phase 1 of the New Policy

According to the OWCP DFEC, the first phase of the policy focuses specifically on FECA claims for new prescriptions of opioid medications — that is, claims on prescriptions for any patient who has not been prescribed an opioid medication within the last 180 days. For these claims to be processed, the following regulations are now in place:

a) There is a maximum 60-day authorization for opioid drug prescriptions. If the physician determines that additional opioid medication is needed after 60 days, a Letter of Medical Necessity (LMN) must be submitted to the OWCP DFEC in order for the claim to be processed.

b) For each fill and refill, the prescription must provide no more than a 30-day supply, or the claim will not be processed. The OWCP DFEC also recommends that physicians prescribe supplies in shorter durations whenever possible.

c) No more than two opioid medications will be authorized by the OWCP DFEC at one time. Claims for additional prescriptions will not be processed.

d) For compounded medications containing opioids, an LMN must be approved prior to dispensing. Otherwise, the claim will not be processed.

Phase 2 of the New Policy

Phase 2 of the new policy has not yet been implemented, but the OWCP DFEC reports that it will address “legacy opioid claims” for prescriptions that were written within the last 180 days. More information will likely be released in the coming weeks and months.

For medical billing staff at the offices of small physicians, it can be challenging to keep track of changing regulations for workers’ compensation claims for opioid medications. In order to avoid claims processing issues, it can be helpful to consult with the experts at AnnexMed. Our team of professionals is always on top of the latest changes in workers’ compensation policies, so we can help you manage challenges that could otherwise disrupt your revenue cycle. Contact us today for more information!

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