IBR

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...

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...

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...

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...

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...

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...

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...

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...

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...

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...

CA DWC Lets SCIF Skirt IBR for Incorrect GPCI

In a baffling decision, the California Division of Workers’ Compensation (DWC) declared a straightforward billing dispute ineligible for Independent Bill Review (IBR) — despi...

Sedgwick Defies DWC COVID Rules; DWC Washes Hands

Sedgwick defied California workers’ comp regulations, costing a provider thousands in due reimbursement. Unfortunately, the Division of Workers’ Compensation (DWC) has declin...