An Independent Bill Review (IBR) is a process in California’s workers’ compensation system to resolve billing disputes between medical providers and claims administrators. Medical bills often get denied due to exceeding pre-authorized approvals or improper documentation, making it one of the key medical billing challenges providers face.
According to the California Code of Regulations,
Title 8, Section 9792.5.12, providers can file an IBR when there is a dispute over the payment amount.
The filing fee is $180 per application, reimbursable if the provider wins the dispute. Although the IBR process can effectively overcome medical billing challenges, many medical providers hesitate to file due to the high fee and time-consuming method.
This table shows the breakdown of IBR cases by different medical service types from 2022 to 2024. According to the data provided on the DWC website, 5,704 cases were filed, ranging from durable medical equipment to pharmaceuticals.
Case Nature | Count of Case Number | ||
| Overturned | Upheld | Total Number | |
| Durable Medical Equipment, Prosthetics, Orthotics, & Supplies | – | 4 | 4 |
| Hospital Outpatient Departments & Ambulatory Surgical Centers | 348 | 54 | 402 |
| Inpatient Hospital Services | 95 | 14 | 109 |
| Interpreter | 2164 | 17 | 2181 |
| Medical-Legal Fee Schedule | 573 | 26 | 600 |
| Pathology and Laboratory Services | 352 | 2 | 534 |
| Pharmaceutical | 234 | – | 234 |
| Physician Services | 1567 | 253 | 1820 |
| Grand Total | 5334 | 370 | 5704 |
Data from the provided cases shows that approximately $1,026,720 was spent on IBR filing for a total of 5704 out of which 5334 were overturned.
This means that the providers not only collected these bills but also got their $180 reimbursed. These filings resulted in a profit for the overturned cases which was more than the filing fee.
For those wondering how to overcome medical billing challenges, MLM’s expert negotiators and certified billers specialize in overturning billing disputes and securing the payments providers deserve. The process from filing the IBR to getting a response from the administrator takes about six months on average. Though it may seem lengthy, the results are worth the effort and will help increase revenue if you partner with us.
MLM ensures that our providers collect the maximum amount for their services. Our experts submit comprehensive documentation and strong justifications for IBR filing, following proven steps to overcome challenges in medical billing. We regularly update our clients on the process. Even if an initial decision is upheld, our legal experts explore further options for appeal. Contact us today to avail of our expert services.
