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

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.

A look at the first five years

California’s bill review program went into effect in 20013. It established an Independent Bill Review Organization (IBRO) to resolve medical treatment and medical-legal billing disputes in which a medical provider disagrees with the amount paid by a claims administrator after the provider has requested a second review from the payer.

The DWC report covers the program’s first five years, 2103-2017, including the status of cases filed in 2017 that were resolved in the first quarter of 2018. During that time, Maximus Federal Services (the IBRO) received 9,890 applications for bill review.