The Zenith Unsucessfully Attempts to Undermine IBR Request
Oct 14, 2019
Claims administrators continue to innovate new techniques that make it harder for providers to receive proper reimbursement. In this installment, we tell a tale of the length...
Liberty Mutual and a Cautionary Tale of Payment Woes
Oct 3, 2019
Today we’re sharing a maddening and all-too-common story of payment woes, this time featuring Liberty Mutual as the miscreant that just won’t pay a bill correctly -- despite ...
Liberty Mutual, Gallagher Bassett, Chubb Scoff at CA IBR Rules
Sep 4, 2019
It’s still happening: claims administrators including Liberty Mutual, Gallagher Bassett, and Chubb are ignoring the rules regarding Independent Bill Review (IBR), brazenly re...
Blatant Disregard for IBR Law by Sedgwick, Gallagher, Athens, Helmsman
Aug 5, 2019
A disturbing pattern is emerging from the results of Independent Bill Review (IBR) decisions in the state of California. As usual, the problem encumbers workers’ comp provide...
Liberty Mutual IBR Noncompliance: Unfair and Odious
Apr 17, 2019
After 124 days and 13 phone calls, Liberty Mutual fails to pay a $195 IBR fee ordered by Maximus. Employers need to take heed of this unlawful tale and make sure that ...
SCIF IBR Disputes Are Further Proof of Provider Reimbursement Chaos
Mar 7, 2019
We are again chronicling the reimbursement pandemonium inflicted on providers by the current California Second Review appeal and Independent Bill Review (IBR) processes.
IBR Appeal Analysis for CPTs 99358 & 99359
Feb 19, 2019
Reimbursements for CPTs 99358 & 99359 are tricky because payers frequently deny reimbursement for services that are not face-to-face with patients. Previously, we presented t...
CA Claims Admins Fail to Comply With IBR Rules
Sep 7, 2018
When the Independent Bill Review (IBR) process overturns a claims administrator’s incorrect denial or adjustment, the claims administrator is legally bound to timely pay what...
E/M Services Denied for Insufficient Documentation
May 30, 2018
Increasingly, claims administrators are no longer downcoding evaluation and management (E/M) services. Instead, many claims administrators are denying charges for E/M service...
When is it Appropriate to File a Lien?
Mar 1, 2018
A second review appeal isn’t always enough. Sometimes, providers must take further action to secure proper reimbursement.When a second review appeal fails to produce t...
How It Works: Independent Bill Review (IBR)
Oct 19, 2017
Think about what workers' comp providers go through to obtain correct payment for treating injured workers. Compliant authorization and billing are taxing enough. Appealing i...
The Parity Problem: How Work Comp Favors Insurers Over Providers
Oct 18, 2017
In disputes over payment in the California workers’ compensation system, insurers have an unfair advantage over providers. At every stage of the billing process, the b...