In today’s post, we talk about EORs, a fundamental component of the medical legal billing process in California. Keep reading to learn what EORs are and their importance to healthcare providers.
What Is an EOR?
An Explanation of Review (or EOR) is a document sent to a healthcare provider by a claims administrator after the payment, adjustment, or denial of a complete or incomplete itemization of medical services.
Medical legal bills must be paid within 60 days of receipt of all required reports and documents, unless the claims administrator contests liability within that 60-day period.
The California Labor Code mandates that EORs include the following information:
- The amount paid
- A statement of the items or procedures billed and the amounts requested by the provider to be paid
- The basis for any adjustment, change, or denial
- The additional information required to make a decision for an incomplete itemization
- Information on whom to contact on behalf of the employer if a dispute arises over the payment of the billing
Why Are EORs Important?
EORs are important because they promote transparency in the medical legal billing process.
If a healthcare provider wants to dispute the amount paid by a carrier, they may request a Second Bill Review (SBR) 90 days after the service of the EOR.
In some cases, the healthcare provider wants to dispute the amount paid even after a Second Bill Review. In those situations, the alternative is to request a non-judicial process known as Independent Bill Review, or IBR.
Note that an IBR cannot be requested until after the claims administrator issues a decision following a Second Bill Review, so everything starts with an EOR — hence their importance.
We talked at length about the SBR-IBR process in this previous entry.
And to learn more about medical legal billing in California, be sure to check out our previous blogs, “California Workers’ Comp Glossary” AND “What Is the Difference Between a QME and an AME?”
Practice IQ: Medical Legal Billing in California
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Start improving the efficiency of your practice today. 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.
