OWCP Interagency Meeting

1
OWCPInteragency Meeting

• June 30, 2004

2
Agenda

• Welcome and Introductions
• SHARE Update
• Shelby Hallmark
• Davis Layne
• ACS Update
• Pete Krah
• Bea Way

3
Safety Health and Return to Employment (SHARE)

• Goals have been announced for all Agencies.
  (Handout included in Folders)
• Halfway through the first year of a three year
  initiative.
• Training continues to assist Agencies meet their
  goals.

4
Here is how we are doing so far
5
CA-1/CA-2 Timeliness(filed in 14 calendar days)
6
CA-1/CA-2 Timeliness(by major agency)
7
Lost Production Days(per 100 employees)
8
Lost Production Days(by major agency)
9
Exceptional Achievements in Timeliness

• Greatest Improvement
• Dept. of Housing and Urban Development
• 56.5 improvement in FY04
• Timeliness up to 53.5

10
Exceptional Achievements in Timeliness

• Greatest Sustained Performance
• Dept. of Veterans Affairs
• 73.2 timeliness in FY04
• Improvement of 7.9

11
Exceptional Achievements in Lost Production Days

• Greatest Improvement
• Department of Defense Agencies
• 20.5 reduction in FY04
• LPD down to 41.0

12
Exceptional Achievements in Lost Production Days

• Greatest Sustained Performance
• Dept. of Air Force
• 33.1 LPD in FY04
• Reduction of 20

13
What is OWCP doing to help?
14
Web-based Resources www.dol-esa.gov/share

• Whats New?
• District Websites
• Contact points
• Calendar of events
• Quarterly regional reports

15
Web-based Resources www.dol-esa.gov/share

• Training
• Front Line Supervisor Training
• Injury Compensation (CA-810)
• Return to Work
• Nurse intervention
• E-Newsletter
• Updates
• Hot Topics

16
Web-based Resources www.dol-esa.gov/share

• Calendar of Events
• District Level
• National Office

17
Whats Coming?

• AQS Report Suite
• Access to Chargeback specific reports for COP
  cases, cases within their first year of
  disability and long term cases.

18
Whats Coming?

• Claimant Query System
• Injured worker access to claim information via
  OPMs Employee Express Sytem.

19
Safety, Health, and Return-to-Employment (SHARE)
Initiative
R. Davis Layne Deputy Assistant
Secretary Occupational Safety and Health
Administration Interagency Meeting June 30,
2004
20
Entering the 21st Century The Status of Federal
Workplace Safety and Health

• In FY 2003, federal workers experienced more than
  150,000 occupational injuries and illnesses.
• These incidents cost American taxpayers more than
  2 billion in workers compensation payments.

21
Occupational Injuries/Illnesses Total Case Rate
(TCR)
22
Occupational Injuries/Illnesses Lost Time Case
Rate (LTCR)
23
Cost of Occupational Injuries and Injuries 2
Billion Annually

• Direct Costs
• Medical expenses
• Return-to-work programs
• Job accommodations for injured workers
• Indirect Costs
• - Lost productivity
• - Training for replacement workers
• - Overtime expenses
• - Reduced product and service quality

24
SHARE - OSHA Goals

• Reduce TCR by at least 3 annually
• Reduce LTCR by at least 3 annually

25
SHARE OSHA Goals (contd)

• Align With
• Presidents human capital goal by focusing on
  strategies to prevent workplace injuries and
  injuries and preserve human resources
• DOLs strategic goal to foster quality
  workplaces that are safe, healthy, and fair
• OSHAs mission to promote and assure workplace
  safety and health and reduce workplace
  fatalities, injuries and illnesses

26
S-T-R-E-T-C-H Goals

• Agencies were asked to set STRETCH
• goals for all 3 years
• Agency TCR LTCR
• Department of Treasury 6 6 (all)
• Armed Forces Retirement Home Board 5 5 (all)
• Farm Credit Administration 100 N/A (04)
• FDIC 5 5 (all)
• Federal Mediation/Conciliation Service 100 N/A
  (04)
• International Trade Commission 100 N/A (04)
• SEC 4 4 (04)
• Selective Service System 75 N/A (04)

27
SHARE Performance Results TCR for Federal
Government (less USPS)

28
SHARE Performance Results (Contd) TCR by Major
Agency
29
SHARE Performance Results (Contd) LTCR for
Federal Government (less USPS)

30
SHARE Performance Results (Contd) LTCR by Major
Agency
31
Estimated Cost Savings Achieving Minimum 3 TCR
and LTRC Goals

• Result in _at_ 14,300 fewer total cases
• 6,600 fewer lost time cases _at_ estimated cost
  savings of 28,000 per case
• 7,700 fewer no lost-time cases _at_ estimated cost
  savings of 7,000 per case
• Total estimated cost savings of _at_ 240 million
• Cost estimates based on the National Safety
  Councils average costs of injuries and illnesses
  for 1998, including direct and indirect costs and
  excluding property damage

32
OSHA Resources How Are We Helping Agencies?

• FACOSH
• Training
• Outreach materials
• OSHA Training Institute
• Councils
• Agency Technical Assistance Requests (ATARs)
• NIOSH Federal Facility Health Hazard
  Evaluations
• Cooperative Programs
• - Voluntary Protection Programs (VPP)
• - Partnerships
• - Alliances
• Web Resources
• Data

33
OSHA Resources Whats on the Horizon?
Send memo encouraging agencies to establish
stretch goals for FY 2005 and FY 2006 Post Q3
data Continue to provide training through the
councils Conduct ATARs upon request Encourage
cooperative relationships with OSHA Target
interventions to high-hazard establishments
Post Q4 data Evaluate first-year results and
report to the President Survey agencies to
identify training needs
34
OSHA Resources Handouts
CDs/Brochure of NIOSH Federal Facility Health
Hazard Evaluations SHARE Informational Package
35
www.osha.gov
36
FECA Overview

• What is the status of FECA?

37
FECA Benefit Obligations Fiscal Years 1994 - 2004
(in millions)

FY 1996 includes one-time accounting
adjustment of 85 million.
38
Lost Production Days in QCM Cases
Nationwide Averages Measured w/in 1st Year from
the Date Wage Loss Began
Calendar Days
39
CA-7s submitted within 7 days By All Agencies
131,659 submitted in FY 2003
40
CA-7 Timeliness received from agencies within
7 days FY 2004, Q1-2
41
Long-term Disability Roll
End-of-Period Snapshot
42
Customer Service Goal Improve Services in Key
Communications Areas Availability -- Increase
Use of Electronic Services (Agency Query System,
IVR, EDI, Website) Access -- Reduce Average
Time in Queue Responsiveness -- Reduce Average
Response Time Effectiveness -- Increase of
Calls Resolved on First Try Quality -- Meet
Standards for Courtesy, Knowledge and Accuracy
And Clear Language
43
Customer Service Goal FY 2004 Results compared
to (Target) Results Target Use of
electronic services 1.077m hits (1.075
m) Avg. Wait Time 4.5 min. (3.2 min) Avg.
Response Time 1.3 days (2.9 days) Calls
Resolved on First Try 79 (61) Met Quality
Standards 80 (90)
44
ACS Where are we?
45
Status Overview

• 200,000 providers enrolled.
• 2,600 calls/day for bill inquiries.
• average hold time under 2 minutes.
• 2,100 calls/day for medical authorizations.
• average hold time of 49 seconds.

46
Status Overview

• 3.74 days for prior authorizations.
• 98 of bills processed within 28 days.
• Adjustments processed in an average 5.8 days.

47
ACS Achievement Hold Time
In minutes
48
OWCP Efforts

• OWCP helping train ACS Client Service
  Representatives.
• Problem solving system has been developed
• ACS Liaisons in each District Office
• District Office Trouble Shooters
• National Office Trouble Shooters

49
Continuing Efforts

• OWCP monitors ACS performance on a daily basis.
• Service Level Agreements (SLAs) measure key
  contract performance levels.
• Ongoing enhancements to ACS web portal

50
Update on Central Bill Pay and Medical
Authorization
51
Topics

• Accessing ACS Web Portal via AQS
• Prior Authorization Process
• Walk-Thru ACS Web Portal
• How Employing Agencies Can Help Providers
• How Employing Agencies Can Help Injured Workers

52
ACS Web Portal Employing Agency Access

• Easiest way to access is through AQS
• Provides information on
• Eligibility
• Authorizations
• Payments
• Can access via https//owcp.dol.acs-inc.com

53
Accessing the ACS Web Portal via AQS

• Bring up desired case in AQS
• Click on Bill Inquiry

54
Accessing the ACS Web Portal via AQS

• There are 3 types of inquiry options
• Eligibility Inquiry
• Bill Status Inquiry
• Medical Authorization Status Inquiry
• Click on desired inquiry

55
Prior Medical Authorization Process

• Using the ACS Web Portal to Check Eligibility
• Services Requiring Authorization
• Using The ACS Web Portal To Check Authorization
  Status
• Timeframes For Completion

56
Services Requiring Authorization

• Eligibility status available via AQS access to
  the ACS web portal http//owcp.dol.acs-inc.com
• Level 1 - procedures do not require authorization
  (for example, Office Visits, MRIs, Routine
  Diagnostic Tests)
• Level 2 - procedures can be authorized by ACS
  often over the phone with ACS
• Level 3 and 4 - procedures require authorization
  by a Claims Examiner but initiated via fax from
  provider to ACS

57
Using the ACS Web Portal to Check Eligibility

• Check service eligibility without calling ACS by
  entering
• valid case number
• valid procedure (CPT) or revenue code
• approximate date of service

58
Using the ACS Web Portal to Check Eligibility

• If the procedure entered is related to the
  accepted condition, the user will see a message
  indicating the approval level of the procedure
  and other case-specific information

59
Using the ACS Web Portal to Check Eligibility

• If the procedure entered into the Eligibility
  Inquiry doesnt match the accepted condition, the
  user will see the following message

60
When Accepted Condition and Procedure Dont Match

• Advise that provider needs to complete the
  Authorization Request Process
• Claims Examiner will determine if claim can be
  expanded for new condition based on information
  in file and information submitted with request
• Claims examiner will determine if additional
  development is needed to determine if claim can
  be expanded to include new condition

61
Timelines for Prior Medical Authorizations

• Level 2 procedures that ACS can authorize take an
  average of 3.5 days
• All spinal surgery and many other surgery
  authorizations require District Medical Advisor
  (DMA) approval and take about 30 days
• In some instances, additional development of the
  claim by the Claims Examiner is needed to approve
  or deny an authorization request. Case
  complexity, claimant responsiveness, employing
  agency responsiveness, and other factors impact
  the timeline for authorization.

62
Notifications Regarding Authorization Request

• Within 2 business days, the authorization request
  is logged into the system, forwarded to the
  Claims Examiner if necessary, or returned to
  provider if incomplete
• If a request for authorization is approved, the
  requesting provider is notified via mail
• If a request cannot be approved because
  additional information is needed, requesting
  provider is notified via mail
• If a request is denied, the Claims Examiner
  issues an official denial letter to claimant
• Authorization status available via AQS or direct
  access to ACS web portal http//owcp.dol.acs-inc.c
  om or via the ACS IVR at 866-335-8319

63
Authorization Letter

• Requesting Provider receives authorization via U.
  S. Mail
• ButNo need to wait for the mail. Check
  authorizations via AQS or direct access to ACS
  web portal http//owcp.dol.acs-inc.com

64
Using the ACS Web Portal to Check Authorizations

• Click on Medical Authorization Inquiry

65
Using the ACS Web Portal to Check Authorizations

• Enables users to check authorization status
  without calling ACS
• Limit the number of authorizations returned by
  entering dates of service range

66
Using the ACS Web Portal to Check
Authorizations
67
Using the ACS Web Portal to Check Bill Status

• Choose to see Resolved or In Process bills
• Dates of Service is optional
• Can search for a particular provider number
• Can search for a particular TCN

68
Using the ACS Web Portal to Check Bill Status

• Displays information on bills submitted bills
• Returns a maximum of 200 bills message tells if
  there are more than 200 bills matching search
  criteria
• To view description of billed diagnosis (ICD9),
  click on hyperlink
• To view line items for a specific bill, click on
  the hyperlinked TCN

69
Using the ACS Web Portal to Check Bill Status

• All line items for the selected bill appear
• To view descriptions for Procedure (CPT),
  Revenue, or EOB codes, click on hyperlink

70
Using the ACS Web Portal to Check Bill Status

• It is possible for some line items to pay on a
  bill and others not

71
How Employing Agencies Can Help Providers

• Encourage providers to register/enroll
• Encourage providers to use ACS web portal
  http//owcp.dol.acs-inc.com for
• Eligibility status
• Authorization status
• Bill payment status
• Link to FAQs
• Encourage providers to bill electronically
• Give Providers accepted condition information
  ICD9s and descriptions when they request it
• Dont submit bills for providers
• Dont complete med auths for providers

72
How Employing Agencies Can Help Injured Workers

• Encourage Injured Workers to use ACS web portal
  http//owcp.dol.acs-inc.com for
• Eligibility status
• Authorization status
• Bill payment status
• Link to FAQs
• Forms
• Give Injured Workers their accepted condition
  information ICD9s and descriptions a screen
  shot from AQS works for this
• Advise/Encourage Injured Workers to give their
  accepted condition information to their treating
  physicians
• Educate Injured Workers about the authorization
  and bill pay processes

73
We appreciate your willingness to work with us to
create a system that works for all of our
customers Injured Workers, Providers, and
Employing Agencies