A progress report from the California Division of Workers’ Compensation on the state’s Independent Bill Review program shows seven of 10 decided cases resulted in additional payment for the provider.
IBR is a process used to resolve billing disputes for medical treatment and medical-legal services provided to injured workers.
The “2018 Independent Bill Review (IBR) Report: Analysis of 2013-2017 Application Filings” summarizes the activity of an essential component of the worker’s comp reform law Senate Bill 863, providing an evaluation of the program during the first five years following its enactment.
Prior to SB 863, a medical provider engaged in a billing dispute with a claims administrator was limited to filing a lien with the Workers’ Compensation Appeal Board in order to determine entitlement to the amount initially billed.
The report accounts for all applications filed to dispute payments not resolved through Second Bill Review during this time period.
The report shows that in the first five years following IBR’s implementation, nearly half the challenged billings (46.2 percent) related to physician services, including visits, consultations, and nonsurgical procedures. The second-highest number of review requests was for services at hospital outpatient departments and ambulatory surgical centers (17.9 percent). Disputes with contracts for reimbursement rates were the third highest (12.6 percent).
Other highlights of the report include:
- The number of IBR applications received averaged 165 filings per month.
- Seven of 10 decided cases resulted in additional payment for the provider.
- Nearly $12.3 million was awarded in overturned case decisions.
“We hope the findings of this report will encourage health care providers to consider using IBR for some of their payment disputes,” DWC Administrative Director George Parisotto said in a statement.
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