Newsline No. 61-12  
December 3, 2012  
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DWC posts draft SB 863 regulations for Independent Bill Review

The Division of Workers’ Compensation has posted to its online forum draft regulations implementing Senate Bill 863’s mandate to establish an independent bill review (IBR) program.

IBR was established to provide a quick, efficient way of resolving billing disputes over medical treatment services and medical-legal expenses. Instead of litigating billing disputes with a final decision made by a judge, IBR turns the decision-making process over to medical billing and payment experts. A medical provider who disagrees with the amount paid by a claims administrator on a properly documented bill can, after requesting and receiving a second review, request IBR.

IBR will only resolve disputes regarding the amount of payment owed the physician or provider under fee schedules adopted by the Division. IBR will not apply to disputes about treatment authorization (those will go through Independent Medical Review), cases where the injury itself is in dispute, or where there is a dispute about whether or not the provider is authorized to treat the injured worker.

The IBR regulations include: definitions, the procedure and form for a second review, the procedure and form to request an independent bill review, the initial review and assignment process, how to file documents for the IBR, when bills may be consolidated, and implementation of the determination and appeal.

The forum can be found by clicking the “current forums” link on the top of the DWC forums page.

Comments will be accepted at the forum through Dec. 7, 2012. Please feel free to participate in this important process.