California Medical-Legal physician evaluators, Independent Bill Review (IBR) is your friend.

According to data from the Division of Workers’ Compensation (DWC), 96% of IBR disputes over Medical-Legal bills in 2023 resulted in an ‘Overturn’ decision — as in, the state overturned the claims administrator’s payment denial or adjustment and ordered further reimbursement to the physician.

The numbers for daisyCollect’s Medical-Legal clients are even better; 100% of the IBR disputes initiated by daisyCollect on behalf of physician evaluators resulted in an ‘Overturn’ decision.

See the complete 2023 IBR data below. If claims administrators improperly deny or reduce your Medical-Legal bills and subsequently deny your appeals, it’s time for IBR.

If you are unclear about a denial or reduction, reach out to daisyBill through our chat function; we’re here to help the entire workers’ comp community.

Med-Legal IBR Data: CA Physicians Rarely Lose

For all the inequities and systemic issues that allow claims administrators to improperly deny or adjust reimbursement, California’s IBR system is a reliable safety net for Medical-Legal physicians.

As shown below, Maximus (a private entity which conducts IBR on behalf of the DWC) almost invariably determines that the physician’s bill was correct per the Medical-Legal Fee Schedule (MLFS).

daisyCollect’s track record for 2023 was in keeping with the statewide statistics. Our agents collected an additional $83,000 for Qualified Medical Evaluator (QME) and Agreed Medical Evaluator (AME) clients — money that would otherwise have been lost to claims administrators’ erroneous denials and adjustments.

*While all 41 IBR decisions overturned the claims administrator’s bill adjudication, the amounts awarded to the provider by Maximus did not always equal the amounts disputed initially.

CA Physician Evaluators - Always Appeal!

IBR could be better. Not every decision Maximus makes is correct, and the DWC has deemed far too many disputes “ineligible” for IBR due to glaring loopholes in the IBR requesting process. But for providers in general — and Medical-Legal evaluators in particular — sticking to best practices will likely result in a win.

Always submit a Second Review appeal within 90 days of receiving an initial Explanation of Review (EOR) indicating an improper denial or adjustment. If the claims administrator fails to pay up, request IBR within 30 days of the date on the final EOR.

For our clients, daisyBill billing software generates and submits a complete IBR request packet, which contains everything required in a compliant request for IBR, including:

• IBR cover sheet with supporting documents index
• Completed DWC Form IBR-1
• Copies of the Original Bill, Second Review appeal, and EORs
• All supporting documents
• Proof of service template

And, of course, daisyBill experts want to help you know the rules and use IBR to your advantage. Don’t hesitate to reach out using the chat function in this page's lower right corner, or email your questions to info@daisybill.com.

 Med-Legal billing requires specialized expertise. daisyCollect professionals use our advanced software (and years of experience) to protect your practice. Schedule a 15-minute chat with us below.

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