Medical legal billing in California can be a challenging topic if you don’t know some basic terms. From EOR to IBR, in this post we outline the meaning of all the acronyms and medical terms you need to know to make sense of medical legal billing in the Golden State.
AME
The acronym AME Stands for Agreed Medical Evaluator.
When the diagnosis of a treating doctor is being disputed and the worker has an attorney, then the attorney and the claims administrator choose together an AME to perform a new medical legal evaluation.
EOR
Explanation of Review, or EOR, is a document that explains the payment or the denial of payment in a workers’ compensation claim.
IBR
An Independent Bill Review (IBR) is a non-judicial process for resolving medical-legal billing disputes when a health care provider disagrees with the amount paid by a claims administrator after a Second Bill Review.
QME
QME stands for Qualified Medical Evaluator.
In California, when either the worker or the employer want to dispute the determination of a treating doctor in a medical legal evaluation, a new evaluation is necessary. If the worker does not have an attorney, they can select a QME to perform this evaluation.
Medical Legal Expenses
California law defines medical-legal expenses as any cost incurred to prove or disprove a workers’ compensation claim. This may include things like X-rays, medical testimony, and interpreter’s fees by a certified interpreter.
NON-IBR Petitions
The SBR/IBR process is used to settle disputes between medical legal providers and claims administrators where the dispute is related to the amount to be paid to the medical legal provider.
For all other disputes (such as threshold issues, or to determine whether the medical legal expense was reasonably incurred) it is necessary to file a NON-IBR petition.
SBR
A Second Bill Review, or SBR, is a process that allows healthcare professionals to dispute the amount paid by a claims provider (usually an insurance company) for medical-legal expenses.
Practice IQ: Medical Billing Services in California
At Practice IQ, we have made it our mission to take the administrative burden of medical billing off your hands so you can focus on what you do best.
We are located in Pomona, California, and serve clients all over the Golden State. Contact us today by telephone (424-433-5704) or email (piqusinfo@practiceiqusa.com), or fill out the contact form to learn more about our services.