Independent Bill Review (IBR) Update 2021

Applications Filed

2020- 2021 IBR Filings Jan Feb Mar Apr May June Jul Aug Sep Oct Nov Dec Total
Total Number of IBR Applications Received by the IBR Organization 151 217 241 223                 832
Total Number of Applications Deemed Eligible in the Month 105 116 184 204                 609

Applicable Fee Schedule

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.

Applicable Fee Schedule Count
Physician Services 492
Interpreter Services 101
Medical-Legal Fee Schedule 96
Hospital Outpatient Department & Ambulatory Surgical Centers 83
Contract for Reimbursement Rates 46
Pathology & Laboratory Services 36
Inpatient Hospital Services 24
Pharmaceuticals 16
Durable Medical Equipment, Prosthetics, Orthotics & Supplies 2

Case Outcomes

  • Overturned – The IBRO has determined that additional reimbursement is warranted.
  • Upheld – The IBRO has determined that no additional reimbursement is warranted.

There have been 522 case decisions issued in 2021. The 475 overturned cases issued total $652,000 in additional reimbursement to the IBR applicants.

Disposition Year-to-Date
Overturned Case Decision 475
Upheld Case Decision 47
Ineligible Application 82
Withdrawn Application 29
Total 633

May 2021