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Good Morning
11:11:38 AM 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)  

Payment Delays
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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