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6:51:06 PM CDT
Thursday, April 24, 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)  

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:

  • Ambulance
  • Ambulatory Surgical Center (ASC)
  • Anesthesia
  • Dental
  • Durable Medical
  • Evaluation & Management
  • Home Health Equipment (DME)
  • Hospital (Inpatient)
  • Hospital (Outpatient)
  • Medicine (includes Chiropractic)
  • Pathology & Lab
  • Radiology
  • Physical & Occupational Therapy
  • Surgery

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.

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