In September 2012, Governor Brown signed into legislation Senate Bill (SB) 863. This reform of the workers’ compensation system in California included Independent Bill Review (IBR), which went into effect January 1, 2013. IBR is an efficient, non-judicial process for resolving medical treatment and medical-legal billing disputes in which the medical provider disagrees with the amount paid by a claims administrator on a properly documented bill after a second review.

The DWC just posted a progress report on the department’s Independent Bill Review program.

The 2020 Independent Bill Review (IBR) Report: Analysis of 2018-2019 Application Filings summarizes the activity of an essential component of Senate Bill 863, providing an evaluation of the program during the previous two calendar years. The report accounts for all applications filed to dispute payments not resolved through Second Bill Review during this time period.

Maximus Federal Services, the IBRO, provides the DWC with data extracted from its proprietary software. This data corresponds with information in the Final Determination Letters (FDLs) that are received by the filing parties. Anonymized copies of FDLs for cases decided in the current year are available on the DWC website within thirty days of their issuance

In 2018 and 2019, a similar number of IBR applications was received by the IBRO: 1,692 and 1,644, respectively. These are the first two years since the first year of the program in which application filings fell below 2,000. Each quarter in the two calendar years had a steady pace of IBR filings, ranging from 353 to 483 per quarter.

In 2018, one in three applicants was a provider based in the San Francisco Bay Area (34.9%), and one in four (26.6%) practiced in Los Angeles County. In 2019, nearly half the applications (48.7%) were from Bay Area providers, and applications from Los Angeles fell 25% from the previous year.

Approximately one in four IBR applications is determined to be ineligible for review. Ineligibility factors include untimely requests, requests made prior to completion of a second review, and requests made without payment of the required fee.

Among the filings that received a review and a case determination in 2018, 47% were overturned, meaning the IBRO determined that additional reimbursement is warranted. In 2019, 59.1% of the case determinations were overturned.

Overturned IBR case decisions for applications filed in 2018 and 2019 resulted in reimbursement to the providers totaling $3,823,402. This amount includes the repayment of the filing fees for these cases. The filing fee remains set at $195.

The report is posted on the DIR website.