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Author Archives: myen

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Revised Procedures for In-Facility Pulmonary Rehabilitation

Category : Uncategorized

The Division of Coal Mine Workers’ Compensation (DCMWC) has revised the procedures for providing pulmonary rehabilitation services at a health care facility to eligible coal miners whose benefits are paid by the Black Lung Disability Trust Fund. Based on the expertise of the physicians, hospitals, and clinics that treat coal miners who have black lung disease, DCMWC is eliminating the pre-certification requirement for pulmonary rehabilitation services, as well as updating and streamlining our procedures related to pulmonary rehabilitation services provided at a health care facility. Please note that DCMWC will not pay for at-home pulmonary rehabilitation services.

For miners and providers, the new procedures mean:

  1. A medical facility no longer has to be pre-certified as a PR facility to provide pulmonary rehabilitation services;
  2. A miner no longer needs a Certificate of Medical Necessity (CMN) from a physician to receive pulmonary rehabilitation services;
  3. Physicians may refer patients directly to a pulmonary rehabilitation provider without pre-approval by DCMWC.

Pulmonary rehabilitation providers must be enrolled in the DCMWC Provider Network in order to treat miners and receive payment for services. To enroll as a DCMWC provider, please access: https://owcpmed.dol.gov/portal/main.do for enrollment instructions.

All bills for pulmonary rehabilitation services must be submitted on the OWCP-1500 claim form. A downloadable OWCP-1500 form is available at: http://www.dol.gov/owcp/dfec/regs/compliance/OWCP-1500.pdf. Providers must use Healthcare Common Procedure Coding System (HCPCS) code G0424 when billing for pulmonary rehabilitation services. A bill for pulmonary rehabilitation services must include at least one of the following mandatory components:

  1. Physician-prescribed exercise;
  2. Education or training;
  3. Psychosocial assessment;
  4. Outcomes assessment; or
  5. An individualized treatment plan.

DCMWC will pay for up to a maximum of 60 one-hour treatment sessions during any 90 day period; or a maximum of 90 one-hour sessions during any 12 month period. Lifetime maximums may also apply.

In accordance with 20 CFR 725.707(b), DCMWC may require reports of treatment from time to time, including an individualized treatment plan for each patient.

There is no change in the procedures for billing for other medical services that may be related to pulmonary rehabilitation services. For example, bills for established patient office visits and pulmonary function tests still do not require a CMN and can be billed separately as they are now. There is also no change in the procedures for prescriptions for durable medical equipment (DME) or home nursing care, which will continue to require CMNs.

All medical bills should be sent to:

DCMWC/Federal Black Lung Program
P.O. Box 8302
London, KY 40742-8302


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Final Rule Governing the Black Lung Disability Trust Fund’s Payment of Medical Benefits Has Been Issued

The Office of Workers’ Compensation Programs has issued a Final Rule governing the Black Lung Disability Trust Fund’s payment of medical benefits under the Black Lung Benefits Act.

The Final Rule:

  • Adopts modern payment formulas for physicians, hospitals and other providers that are derived from the formulas used in the Medicare program. These formulas are also similar to those used by other OWCP programs (e.g., Federal Employees Compensation and Energy Employees Occupational Illness Compensation programs).
  • Codifies the black lung program’s current practices for the payment of prescription drugs and the submission of medical bills for payment.
  • Provides greater clarity about fees paid to providers, which should speed processing and payment of benefits as well as make it easier for the Trust Fund to obtain reimbursement from coal companies.
  • Prohibits providers from seeking additional payments from miners for covered services that have been paid by the Trust Fund.

Miners will not see any change in the medical care they receive to treat their black lung disease.

The regulations will be effective August 31, 2018.  The rules will apply to medical equipment, prescription drugs, and inpatient medical services provided or rendered after that date. The rules governing payment of professional medical services and outpatient medical services have a delayed application date and will apply to services rendered after November 30, 2019.

DOL Press Release of Final Rule

The Final Rule is available for public inspection today on the Federal Register’s website at: https://www.federalregister.gov/documents/2018/06/14/2018-12418/black-lung-benefits-act-medical-benefit-payments. The Federal Register will publish the rule on June 14, 2018. The published version will be available online at the same website location.


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Majority of mining-related injuries and illness in Illinois go unreported

Category : Dr. Robert Cohen

Illnesses and injuries associated with working in Illinois mines are underreported. Researchers lead by Dr. Robert Cohen, clinical professor of environmental and occupational health services in the University of Illinois at Chicago School of Public Health, took a deeper look into why this was the case.

Read the UIC Today article


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Why is mining-related lung disease on the rise?

Category : Dr. Robert Cohen

UIC Today covers the research project, led by Dr. Robert Cohen, that looks to determine why mine dust-related lung diseases are on the rise.

Read the article


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Congress Boosts ‘Black Lung’ Treatment Funding by Millions

Category : News

“Rural medical clinics that are struggling to respond to an epidemic of a fatal lung disease plaguing coal miners received a 40 percent boost in federal funding with the passage of the omnibus spending bill last week.” – Howard Berkes, NPR –

Read the entire article on NPR.org.


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