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INDEPENDENT BILL REVIEW (IBR)

SB 863  amended Labor Code §4603.2 to provide, in subsection (b)(1) "Any provider of services provided pursuant to Section 4600, including, but not limited to, physicians, hospitals, pharmacies, interpreters, copy services, transportation services, and home health care services, shall submit its request for payment with an itemization of services provided and the charge for each service, a copy of all reports showing the services performed, the prescription or referral from the primary treating physician if the services were performed by a person other than the primary treating physician, and any evidence of authorization for the services that may have been received...."  In subsection (e)(1), "If the provider disputes the amount paid, the provider may request a second review within 90 days of service of the explanation of review or an order of the appeals board resolving the threshold issue as stated in the explanation of review pursuant to paragraph (5) of subdivision (a) of Section 4603.3. The request for a second review shall be submitted to the employer on a form prescribed by the administrative director and shall include all of the following....."

SB 863 then added Labor Code §4603.6: "(a) If the only dispute is the amount of payment and the provider has received a second review that did not resolve the dispute, the provider may request an independent bill review within 30 calendar days of
service of the second review pursuant to Section 4603.2 or 4622."

These statutes do not mandate the use of IBR, but the provider cannot file a lien until completing the IBR process: see Liens. The DWC webpage states: "Medical treatment and medical-legal billing disputes will now be resolved through an independent bill review (IBR) process. A medical provider who disagrees with the amount paid by a claims administrator on a properly documented bill may apply for IBR. IBR applies to any medical service bill where the date of service is on or after Jan. 1, 2013 and where the fee is determined by a fee schedule established by the DWC."

Also note that "On and after October 18, 2012 claims administrators shall conform to the payment, communication, penalty, and other provisions contained in the California Division of Workers’ Compensation Electronic Medical Billing and Payment Companion Guide." 8 CCR 9792.5.3

8 CCR §9792.5.4 .Second Review and Independent Bill Review: "This section is applicable to medical treatment rendered, or medical-legal expenses incurred, on or after January 1, 2013."

Labor Code §4603.2(e)(1) provides that if a provider disputes the amount paid, the provider may request a second review within 90 days. Subsection (e)(2) provides: "If the only dispute is the amount of payment and the provider does not request a second review within 90 days, the bill shall be deemed satisfied and neither the employer nor the employee shall be liable for anyfurther payment."

Labor Code §4622(b)(2) provides: "If the provider does not request a second review within 90 days, the bill will be deemed satisfied and neither the employer nor the employee shall be liable for any further payment."

Label Item Links Comments
Labor Code See above
   
Regulations/Rules Application of the Official Medical Fee Schedule (Treatment)

Final regs

Electronic billing regs
Payment for Treatment


Final regs

Billing regs
 
Forms Provider’s Request for Second Bill Review

Request for Independent Bill Review
Second bill review

Request for IBR form
 
Websites Independent bill review (IBR)

Answers to frequently asked questions about Independent Bill Review (IBR)
DWC IBR

IBR FAQ
 
Practice Tips     
Articles
IBR, etc.: handout from DWC 21st annual educational conference 2/14 (p. 13)

It’s Here--Independent Bill Review (Part 1) by David Bryan Leonard, Esq.

It’s Here--Independent Bill Review (Part 2) by David Bryan Leonard, Esq.

IBR, etc.

IBR I-Leonard


IBR II-Leonard


 

"All in all, [Leonard] finds the IBR process to be limited in its capacity, time consuming and costly. The IBR process is tantamount to a calculator where the participants cannot agree on which numbers to use. The IBR is not a dispute resolution process to the extent that it cannot address any issue other than numbers. It cannot consider contested treatment or coding disputes. It cannot make a determination of need for treatment. The purpose of the IBR is to process codable services." 

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