California’s Department of Industrial Relations (DIR) and the Division of Workers’ Compensation (DWC) released a status report on their Independent Bill Review (IBR) program. IBR is used to resolve billing disputes for medical treatment and medical-legal services provided to injured workers.

The “2018 Independent Bill Review (IBR) Report: Analysis of 2013-2017 Application Filings” gives an evaluation of the program five years after it began.

For applications filed between 2013 and 2017, 55 percent were overturned, 22 percent were upheld, 17 percent were ineligible, and 6 percent were withdrawn.

They found that the number of IBR applications received averaged 165 filings per month. Since the program’s inception the number of applications increased each year, decreasing about 10 percent in 2017 from prior years.

In the five years after implementation 46.2 percent of challenged billings related to Physician Services, including visits, consultations, and nonsurgical procedures. The second-highest number of review requests (17.9 percent) was for services at hospital outpatient departments and ambulatory surgical centers. Disputes with contracts for reimbursement rates were the third highest (12.6 percent).

Seven of 10 decided cases resulted in additional payment for the provider, and almost $12.3 million was awarded in overturned case decisions.

Read the press release from DIR and read the report here.