70% Of Workers’ Comp Billing Disputes End Badly For California Payers

A performance report on the first five years of California’s independent bill review program reveals that claims adjusters’ billing decisions rarely align with how the state workers’ comp system sees things. According to the latest report from the California Dept. of Industrial Relations’ Division of Workers’ Compensation (DWC), more than 70 percent of workers’ comp bills submitted to the state for bill review adjudication are decided in favor of the medical provider disputing the amount remitted by payers. That means that in seven out of 10 cases, not only are payers on the hook for additional medical costs, they also have to pick up the tab for the review fee.