Billings, Medical Payments, and Fee Schedules
North Dakota Century Code authorizes Workforce Safety & Insurance
(WSI) to establish medical and hospital fee schedules. The fee schedule
is a list that establishes the recommended maximum level of reimbursement
for medical services. A fee schedule usually has two components:
a relative value scale and a monetary conversion factor. The fee
schedule also establishes guidelines for payment of services.
These guidelines may include limitations on the number of allowed
treatment, restrictions on frequency of service, or requirements
for treatment plans. WSI currently has the following fee schedules:
- Ambulatory Surgical Center (ASC)
- Durable Medical
- Evaluation & Management
- Home Health Equipment (DME)
- Hospital (Inpatient)
- Hospital (Outpatient)
- Medicine (includes Chiropractic)
- Pathology & Lab
- Physical & Occupational Therapy
WSI does utilize the American Medical Association’s (AMA)
Physicians Current Procedural Terminology (CPT®) in the reimbursement
for medical services. All level I and level II HCPC’s codes are
updated annually in accordance to the publication of new or deleted
codes by the AMA. WSI does incorporate different reimbursement
methodologies for different types of services being performed.
WSI does strive to have a reimbursement system that equitably
pays for the services provided to injured workers. To review the
full scope of the Fee Schedules, you are required to accept the
disclaimer language, as outlined by the AMA.
WSI pays in full any charges submitted that are less than or
equal to the maximum allowable fee as designated by the appropriate fee schedule.