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Tuesday, February 10, 2015

Administration Hopeful IBR Will Further Reduce Liens

  • By Greg Jones
  • State: California
  • Topic: Top
  • - Popular with: Legal
  • -  0 shares
LOS ANGELES – Lien filings dropped more than 50% after the lien provisions in Senate Bill 863 …

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Anne Bazel Nov 3, 2016 a 2:58 pm PDT

It's either they are blind or just playing stupid. How do you expect a provider, whose reimbursement averages less than $100 for a specific service to pay $250 to get a higher payment of some 10-20%. This whole system of IBR is a sham created to discourage providers from fighting for their rights. IBR makes it financially non-feasible for provider to appeal the underpayment either through IBR and thus leaving no option to file a lien.

They want to see an increase in filing of IBR, make the carrier pay the fee, the way it should've been done fairly from the beginning. I bet, then, it would be at part with IMR.

Charles Cleveland Nov 3, 2016 a 2:58 pm PDT

I agree, the system was designed to drive out providers, throw up more roadblocks to reimbursement and make the system so cumbersome for doctors that it makes no business sense to treat injured workers.

Cornelia Sterner Nov 3, 2016 a 2:58 pm PDT

The carrier pays it if they owe one penny more. The reason the carrier does not pay it up front was there was too much room for retaliation.

Kennedy Yip Nov 3, 2016 a 2:58 pm PDT

I have done lien work from both sides. I have seen bad behaviors from providers and equally bad ones from carriers. Isn't the IBR filing fee reimbursable, if the carrier owes a penny more? If so, why worry if you are so certain you are right that you are owed more? Yes, definitely fronting the fee is bad for cash flow for good providers like you, but some bad providers did this to you. When it was all free, the mentality of some bad providers was file one anyway, because the costs the carrier would incur to defend the lien would likely outweigh the costs of just paying the "ransom", so to speak. The free-riding lien-filing system was undoubtedly inundated with frivolous liens mostly filed by a small number of bad providers. In order to discourage them, you (the good providers) are being asked to now front the filing fees (for IBR and liens in general). Imagine if Small Claims Courts were free, there would be millions more filings. Now since there is a fee, mostly only providers who really feel they are owed are filing. And when they win, the carrier pays them back the filing fee.

Anonymous Nov 3, 2016 a 2:58 pm PDT

injuredJD. You are right. It's mostly the pissed off guys that are filing though. The problem is that most offices don't have a properly trained bill reviewer. They hire off the street and train them in-house or hire someone who worked in another clinic. Bill reviewer up until last year were certified in-house by insurance companies. So these clinics lack confidence to ante up. Those who file are doctors or doctors with staffs who know the labor code and feel that they can successfully challenge the insurance company. I have personal experience in this.

Anonymous Nov 3, 2016 a 2:58 pm PDT

Ha. It should be parasite o. IBR is a way for payors to game the system. If IBR is awarding more money 59% of the time you need to do the math. That means 60% of the time carriers are ripping off the providers. Baker, Overpeck and Parasite o should be lynched. Wait another year when the stats come out showing how many payors actually received free services because time frames have elapsed to file secondary bill review and IBR. The DWC is the one of the most corrupt entities in this state. Wake up folks.

Cornelia Sterner Nov 3, 2016 a 2:58 pm PDT

Your comment does not make any sense. The carriers cannot get "free" services since the time frames for the second appeal and IBR do not trigger until the provider has received a payment with an EOB to appeal.

Anonymous Nov 3, 2016 a 2:58 pm PDT

actually number is higher than 60%. Because some bills are outright denied. But some are illegally discounted or wrongly bundled. For example, they'll apply network discount to doctors who aren't even in the network. A lot of times, because these amounts are little providers decide to take the loss rather than have someone file appeals as having the personnel to do so costs more money and headache to run. So insurance companies get to get away with a lot of their mishaps.

Anonymous Nov 3, 2016 a 2:58 pm PDT

Law advocate. Have you ever had a piece of mail that maybe was mis filed or not received at all?? If that happens with an EOR and then the 90 day timeframe expires to file for the SBR the provider is SOL and the way the regs are written says they have no recourse to ever collect those funds. So what is stated above makes perfect sense. What if you billed for your legal services and a client could just mail a letter stating they didn't like the fees. Then 90 days passes and you did not fill out some ridiculous forms and you are never allowed to collect those fees. You would be screaming and yelling. Obviously you are completely out of touch with the real world.

Anonymous Nov 3, 2016 a 2:58 pm PDT

If you analyse actual reasons for denials, one finds that most aren't IBR issues. For example, MPN denial accounts for 1/3 of the EOB's. Other 3rd is denied case/denied body part. Of the remaining 1/3, a lot of it is medical necessity issue connected to UR. So in essence, there's small percentage of EOB's that would qualify for IBR. And of those, large number of the bill is illegal adjustment. One way or the other, it's bill reviewer from insurance companies that screw up. To have provider to ante up and have the burden of proof for the screw up is not only unfair, it's illogical. And then to say it's under utilized? Somebody really has no idea what's going on in Sacramento...

Anonymous Nov 3, 2016 a 2:58 pm PDT

So why do providers have to ante up to prove insurance company's mistake? It's to prevent over utilization like what you see in IMR. Trust me, there are plenty of bad guys that'll do that just out of spite. So in essence the system is treating all providers as the bad guy. Assume everyone's unscrupulous..and when you prove you really were right, then we give you your money back. My question is, if you were treated like this in any other system, would you stay? But in WC, most will stay. Because most are screw ups. They don't know how to treat properly and WC gives umbrella from malpractice. So this is the only gig and you just have to find a work around for all these lowly treatments. If you were halfway decent as a physician, you'd been out long time ago. Why would you be treated like criminal by the state. Hey... I'm out. And like to say to all of you ...so long suckers.

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