Today we take a closer look at the Second Bill Review/Independent Bill Review Process, from some basic definitions to the things medical providers should keep in mind when they dispute a medical-legal payment.
What Is a Second Bill Review (SBR)?
The Second Bill Review, or SBR for short, is a process that allows healthcare professionals to dispute the amount paid by a claims provider (usually an insurance company) for medical-legal expenses.
A request for a Second Bill Review must be made within 90 days of the service of the Explanation of Review (EOR) giving the reasons why the initial bill was reduced or denied. (It’s worth remembering that requests for second review of medical-legal bills must be made using this form.)
Within 14 days of receiving the SBR, the claims provider has to respond with an Explanation of Review. If any amount is deemed to be payable, the claims provider has to settle it within 21 days of the request for second review.
However, things aren’t always so clear-cut, and very often healthcare providers need to further dispute the payment. In that case, you can request an Independent Bill Review.
What Is an Independent Bill Review (IBR)?
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.
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.
It’s important to note that when requesting an IBR you have to pay a filing fee of $180. If it is determined that you are owed additional money, then the claims administrator will be ordered to pay the outstanding amount and reimburse you the filing fee.
In an IBR, an Independent Bill Review Organization (IBRO) assigns an independent bill reviewer to examine all the documents submitted and issue a written determination within 60 days of the assignment to IBR.
If you disagree with an IBR determination, you can file an appeal, but keep in mind that you have to do it no later than 20 days after receiving the determination.
Practice IQ: Medical Billing Services in California
Need help with an SBR or IBR? 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.
