In a previous post, we took at the Independent Bill Review (IBR), a process for resolving medical-legal billing disputes in California. But can an IBR determination be appealed? In this post, we give you a detailed answer.
What Is an Independent Bill Review (IBR)?
As we saw in another post, an Independent Bill Review is a non-judicial process for resolving medical-legal billing disputes where the medical provider disagrees with the amount paid by a claims administrator after a second review.
Here’s how it works:
- When a medical provider wants to dispute a payment, they must submit a request to the claims administrator for a second review of the bill.
- If the provider disagrees with the second review, they may request IBR within 30 days of the service of the second review.
- The medical provider can submit their IBR request either electronically or in hard copy.
- Note that there is a fee of $180 for filing an IBR request. If it is determined that additional money is owed to the medial provider, the claims administrator is ordered to pay the outstanding amount plus the filing fee.
Can an IBR Determination Be Appealed?
The short answer is yes, an IBR determination can be appealed.
Providers and claim administrators can appeal an IBR determination issued by Maximus (an independent company hired by the California Division of Workers’ Compensation to conduct bill review services).
They can also appeal a decision by the Acting Administrative Director that an IBR application is not eligible to be reviewed.
Any appeal must be filed with the local district office of the Workers’ Compensation Appeals Board (WCAB) no later than 20 days after service of the determination that is being appealed.
If the original determination is not upheld after the appeal, the dispute will be returned to the Administrative Director with an order to resubmit it to IBR.
To learn more about the IBR appeal process, just click on this link.
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.