In previous posts, we discussed the Independent Bill Review (IBR) / Second Bill Review (SBR) process. But what is an IBR determination, exactly? Keep reading to find out and learn more about this key part of the California medical legal billing system.
A Primer on the IBR Process
An Independent Bill Review, or 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.
In other words, you cannot file an IBR until after the claims administrator has made a decision following a Second Bill Review. You may request an IBR within 30 days after receiving the SBR decision.
The IBR process became effective on January 1, 2013, and applies to all the subsequent dates of service.
What Is an IBR Determination?
Upon referral by the administrative director, the Independent Bill Review Organization (IBRO) notifies the parties, provides them with an IBR identification number, and assigns an independent bill reviewer to examine all the documents submitted.
The independent bill reviewer then applies the corresponding fee schedule (for example, the Medical Legal Fee Schedule) and issues a written determination within 60 days of the assignment to IBR. This is what is known as an IBR determination.
Here, it’s worth noting that there is a filing fee to be paid when requesting an IBR. If the determination finds that any additional amount is owed to the health care provider, then the determination will also order the claims administrator to pay the additional amount owed and reimburse the provider the filing fee.
An IBR determination is binding on all parties, but it can be appealed. Providers can also appeal a decision by the Acting Administrative Director that an IBR application is not eligible to be reviewed.
To learn more about that part of the IBR process, read our previous blog, “Can an IBR Determination Be Appealed?”
Practice IQ: Medical Billing Services in California
Need help navigating the IBR process? At Practice IQ, we have made it our mission to take care of the administrative side of medical-legal reports and billing 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.
