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Good Morning
2:39:08 AM CDT
Wednesday, April 16, 2014

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Billings, Medical Payments, and Fee Schedules

Topics Provider Remittance Advice Forms & Publications E/M Documentation Guidelines
Billing and Medical Payments Reconsideration of Billed Charges Explanation of Benefits (EOB) Codes  
Bill Review Department Billing Options Provider Request for Adjustment (M6)  
Payment Delays Fee Schedule Information Fee Schedules  
Advanced Beneficiary Notice of Non-Payment (ABN)   Advanced Beneficiary Notice (ABN)  

Billing and Medical Payments
Bills must be submitted to WSI within one year of the date of service or within one year of the date WSI accepted liability for the work injury or condition.

WSI utilizes the 1997 coding guidelines as the tool when completing an audit of the Evaluation & Management (E&M) services. The documentation should represent the visit and stand-alone, meaning the necessary criteria to reach the level of code billed should be reflected in the office note.

To assist with timely payment, please follow these guidelines:

  • Bill with the appropriate bill format (CMS 1500 or UB 04)
  • Bill with valid CPT & HCPC codes
  • Follow AMA guidelines for appropriate billing of modifiers
  • Submit supporting documentation for all dates of service being billed
  • Medical necessity of a service is the overarching criterion for payment, in addition to the individual requirements of the CPT code being billed
  • Bill each date of service separately
  • Include the injured worker’s name and claim number
  • If billing unlisted codes, provide a description of the service provided
  • If billing anesthesia the number of minutes should be billed as the units
  • List the ICD-9 code for the service being provided
  • Provide the tax identification number of the facility
  • Provide contact information
  • Provide the treating practitioner’s name and NPI number

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