Workers Comp

Physician services payments most disputed claim in bill program

Angela Childers

January 20, 2021 Reprints

Workers Comp Coverage More + Less -

Usage of California’s workers compensation independent bill review program has declined over the past two years, but the program still received an average of 139 bill review applications per month in 2019, with physician services billing remaining the most disputed claim, according to a report released Tuesday by the California Division of Workers Compensation.

The department’s IBR report found that about $3.8 million was awarded to medical providers in overturned workers compensation case decisions, with providers receiving additional payments in seven of 10 bill review cases.

In 2012, California Gov. Jerry Brown signed legislation to create the IBR, which took effect in 2013, to resolve medical treatment and medical billing disputes. Previously, disputes were only handled by the workers compensation appeals board.

The report found that in 2018 and 2019, about 1,600 IBR applications were received by the department, down from 2,000-plus filings in 2017.

Nearly half of the IBR cases in 2019 included review requests for physician services, with “prolonged evaluation and management service before and/or after direct patient care” listed as the most common complaint, followed by “contract for reimbursement rates” and “hospital outpatient and ambulatory surgical centers,” according to the report.

Billing for physician services was also the most overturned claim, but the highest amounts for highest reimbursements in overturned disputes were for inpatient hospital services and ambulatory surgical centers.