IBRs
Apr 17, 2019
Liberty Mutual IBR Noncompliance: Unfair and Odious
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 ...
Mar 7, 2019
SCIF IBR Disputes Are Further Proof of Provider Reimbursement Chaos
We are again chronicling the reimbursement pandemonium inflicted on providers by the current California Second Review appeal and Independent Bill Review (IBR) processes.<...
Feb 19, 2019
IBR Appeal Analysis for CPTs 99358 & 99359
**Update: The 2021 OMFS updates drastically changed how E/M codes are billed.*Reimbursements for CPTs 99358 & 99359 are tricky because payers frequently deny reimburse...
Sep 7, 2018
CA Claims Admins Fail to Comply With IBR Rules
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...
May 30, 2018
E/M Services Denied for Insufficient Documentation
Increasingly, claims administrators are no longer downcoding evaluation and management (E/M) services. Instead, many claims administrators are denying charges for E/M service...
Mar 1, 2018
When is it Appropriate to File a Lien?
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...
Oct 19, 2017
How It Works: Independent Bill Review (IBR)
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...
Oct 17, 2017
The Parity Problem: How Work Comp Favors Insurers Over Providers
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...
May 23, 2016
🔎 Search Thousands of IBR and IMR Decisions 🔎
With two new workers’ comp tools, searching through past decisions just got a whole lot easier:DWC’s announces super-useful search tool for Independent Medical Review ...