Medical Bill Audit

WSI’s Bill Audit Department conducts a pre-payment audit of all medical bills to detect, prevent, and correct fraud, waste, and abuse. As such, medical documentation must accompany each medical bill.

WSI’s pre-payment audit seeks to ensure:

  • Bills for items or services are related to the work injury
  • The most appropriate and cost effective supplies are being utilized
  • Medical documentation substantiates the service or level of service billed
  • Services or supplies are accurately coded
  • Services provided meet professionally recognized standards/level of care
  • Duplicate or redundant charges are not paid
  • Timely filing
    • Within 1 year from date of service, or
    • Within 1 year from date liability was accepted

Documentation Policies are available, which outline specific documentation components reviewed in WSI’s auditing process. A provider should use the Documentation Policies in conjunction with WSI’s Fee Schedule Guidelines to ensure proper documentation and billing.