IBR
Oct 14, 2021
Zurich Refuses to Pay for Emergency Treatment
In a medical emergency, a doctor treats first and asks questions later. But in response to a medical emergency, Zurich refused to pay a doctor for suturing a lacerated finger...
Sep 22, 2021
Liberty Mutual Stiffs QME - Attorneys Required
Hello California Workers’ Comp Attorneys, Medical-Legal physicians in this state need your help. Payers like Liberty Mutual have found a way to skirt the Independent ...
Sep 15, 2021
SCIF Hacks IBR by Switching (Incorrect) Denial Reason
There’s a serious inequity in the appeals process by which California workers’ comp providers can dispute incorrect reimbursement for authorized treatment. State Compensation...
Aug 23, 2021
ESIS Fails to Pay IBR Fee on Behalf of ABM Industries
Ask yourself — what happens if you’re a year late paying a bill?Your credit score tanks? Your car is repossessed? Your home foreclosed on? In most walks of life...
Aug 17, 2021
Med-Legal Reports: Always Include Page Count Verification!
Preferred Provider Organization (PPO) and other network discounts do not apply to the Medical-Legal Fee Schedule (MLFS). Period.In other words, the MLFS and OMFS are c...
Aug 12, 2021
Med-Legal ML106: IBRs Leave No Doubt
If it wasn’t clear before, it certainly is now. Physicians should bill for supplemental Medical-Legal reports requested before April 1, 2021 with billing code ML106, regardle...
Aug 2, 2021
CA Med-Legal: ML200 Missed Appointment Payable
An Independent Bill Review (IBR) case affirmed one of the biggest changes to California’s Medical-Legal Fee Schedule (MLFS): an established reimbursement for missed Medical-L...
Jul 15, 2021
Sedgwick Violates LACoFD Employer Contract, IBR Drops Ball
A physician agreed to serve as Independent Medical Examiner (IME) for the Labor Management Committee (LMC) representing the Los Angeles County Fire Department (LACoFD) and Lo...
Jul 12, 2021
Sedgwick Denies Second Review Appeals as "Duplicates"
Sedgwick has a Second Review problem.On too many occasions, Sedgwick incorrectly denies providers’ Second Review appeals as “duplicate submissions” of the original bil...
Jul 9, 2021
ML106: Liberty Mutual Must Learn the Rules
California’s all-new Medical-Legal Fee Schedule (MLFS) debuted back in April, but some claims administrators are still a few steps behind. To bill for supplemental Med...
Jul 6, 2021
IBR Hall of Shame: Sedgwick Sets New Standard of Noncompliance
Sedgwick failed to comply with an Independent Bill Review (IBR) ruling for almost four months. Worse, the payor’s brazenness is likely to go unpenalized by the state.T...
Jun 29, 2021
Med-Legal Bill Denied for Liability? Request IBR
Certain California workers’ comp payers deny reimbursement for Medical-Legal evaluations by claiming lack of liability for the initial injury. With this twisted, circular log...