Billings, Medical Payments, and Fee Schedules
One of the unique qualifiers with workers’ compensation is the
compensability of the injury. Factors which may cause a delay in
reimbursement are compensability decisions on the claim. Any time a
decision of acceptance or denial of a claim has been made the injured
worker is notified. The primary physician will also be notified of
the decision. WSI accepts a work related injury for a specific ICD-9
diagnosis. If treatment is for other diagnosis there is a potential
for the charges to be denied.
WSI relies on documentation to support the billed charges.
When supporting documentation is not received, or documentation
does not clearly outline the treatment provided, reimbursement
will be denied. To ensure correct documentation, providers
should always submit the documentation to support the billed
charge. Providers should include the following:
- Area of treatment (lumbar spine)
- Type of treatment
- If billing time based codes, include the length of time for the treatment
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