The Division of Workers’ Compensation (DWC) has added an easy-to-use search tool to help the public find Independent Bill Review (IBR) determinations quickly and efficiently.
The DWC IBR search tool is available on the DWC website.
Over 5,100 IBR cases have been decided since the IBR program was implemented on January 1, 2013. Information for each case is posted to the DWC website after the case is decided. Similar in structure to the Independent Medical Review (IMR) search tool, the public can search for the decisions on dates of application receipt and decision issuance, case decision and applicable fee schedule.
Maximus Federal Services is the current Independent Bill Review Organization (IBRO) contracted with DWC.
The IBR program provides an expedient method to resolve work related injury billing disputes between providers and claims administrators. IBR is available for any disputed medical service bill where the date of service is on or after January 1, 2013 and the fee is determined by the DWC fee schedule.
The new search tool allows decisions to be searched by the applicable fee schedule, in addition to other terms. 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.
The applicable fee schedule search option also breaks down the search into the following sub-categories.
Contract for Reimbursement Rates (not a DWC fee schedule)
Durable Medical Equipment, Prosthetics, Orthotics, Supplies
Hospital Outpatient Departments and Ambulatory Surgical Centers
Inpatient Hospital Services
Medical-Legal Fee Schedule
Pathology and Laboratory Services
While this search option may help users to focus in on an informative decision, it is likely that a user would be looking for a match to an exact billing code or code set rather than a more general category. Unfortunately this new tool does not offer this more narrow functionality.
Nonetheless, the tool may provide guidance to claim administrators and providers regarding the correct application of the OMFS as applied by the Maximus reviewers.