A proposed piece of legislation (AB 399) would limit to $50 the fee to determine eligibility for Independent Bill Review. Here’s what you need to know.
What Is Independent Bill Review (IBR)?
Simply put, Independent Bill Review, or IBR, is a non-judicial process for resolving California medical-legal billing disputes where the medical provider disagrees with the amount paid by a claims administrator after a second review.
Under the current system, a medical provider who disagrees with a second review decision and wants to request IBR has to provide, among other things:
- Completed application for IBR
- Supporting documentation
- IBR fee of $180
If it is determined that a request is not eligible for IBR, the provider receives partial reimbursement of the IBR fee.
On the other hand, if the determination finds that any amount of money is owed to the provider, the claims administrator has to pay said sum and reimburse the provider the amount of the filing fee.
What Are the Changes Proposed in AB 399?
The California Assembly Bill (AB) 399 proposes what it calls the Medical Provider Network Transparency of 2022.
The bill focuses on the IBR process, which would look like this, should AB 399 pass:
- Medical providers would pay a $50 fee (instead of the current $180 fee) to determine if a dispute qualifies for IBR.
- If the IBR process finds that a medical provider is owed money, the bill would require the independent bill review organization to bill the employer for the additional review fees along with the eligibility fee paid by the provider.
- The independent bill review organization would be required to reimburse the medical provider for the amount of the eligibility fee within five business days from the date of the determination that additional payment is owed.
- If it is determined that the provider is not owed any amount of money, the bill would require the independent bill review organization to bill the provider for the additional review fees
- The bill would require employers to pay any additional amounts found owed to the medical provider within 30 days of the final determination.
The full text of the bill is available online here.
To learn more about the IBR process, check out our previous posts, “The Second Bill Review (SBR)/Independent Bill Review (IBR) Process”, and “Can an IBR Determination Be Appealed?”
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