Independent Bill Review (IBR) Update 2023 - Q2
Applications Filed
| IBR Filings | Jan |
Feb | Mar | Apr | May | Jun | Jul |
Aug | Sep | Oct | Nov | Dec | Total |
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Total Number of IBR Applications Received by the IBR Organization | 382 | 328 | 338 | 285 | 238 | 283 | 1,854 | ||||||
| Total Number of Applications Deemed Eligible in the Month | 200 | 187 | 296 | 310 | 246 | 257 | 1,496 |
Applicable Fee Schedule
This is the DWC fee schedule that covers the service for the disputed bill and is used by the IBRO to decide the appropriate reimbursement. Contracts between providers and payers may supersede the DWC fee schedules and are considered separately by the IBRO.
| Applicable Fee Schedule | Count |
|---|---|
| Physician Services | 1,398 |
| Interpreter Services | 1,179 |
| Contract for Reimbursement Rates | 471 |
| Medical-Legal Fee Schedule | 410 |
| Hospital Outpatient Department & Ambulatory Surgical Centers | 252 |
| Pathology & Laboratory Services | 167 |
| Inpatient Hospital Services | 69 |
| Pharmaceuticals | 15 |
| Durable Medical Equipment, Prosthetics, Orthotics & Supplies | 4 |
Case Outcomes
- Overturned – The IBRO has determined that additional reimbursement is warranted.
- Upheld – The IBRO has determined that no additional reimbursement is warranted.
There have been 1,389 case decisions issued this year. The 1,322 overturned cases issued total approximately $1.75 million in additional reimbursement to the IBR applicants.
| Disposition | Total Count |
|---|---|
| Overturned Case Decision | 1,322 |
| Upheld Case Decision | 67 |
| Ineligible Application | 826 |
| Withdrawn Application | 54 |
| Total | 2,269 |
July 2023