ibr delays decisions on late QME payment penalties (Californ

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ibr delays decisions on late QME payment penalties (Californ

Postby mk61347 on Fri Nov 07, 2014 3:16 am

Has anyone filed for penalties plus interest on late QME exams an received a decision?

I have two cases from qme exams in which I asked penalties plus interest for late payment. Both cases were marked as received on 9-27-2013. In one case the insurance company paid the penalties plus interest upon notification that the IBR process had been started.

I have faxed maximus twice requesting a refund for the settled case and received no response. I have sent an email to the address supplied by the IMC for IBR questions and received no response. I have called teidi , the iBR specialist from the IMC, and left messages on the problem and received no response.

Any suggestions?

I have a third case for penalties in which it took the insurance company almost a year to pay for my QME exam. My second bill review request was denied as a duplicate charge. Since there really was not a second bill review do file with the local board for failure to produce a timely response or proceed to IBR
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Re: ibr delays decisions on late QME payment penalties (Californ

Postby appliedpsych on Sat Nov 08, 2014 9:44 am

I have had one IBR. It was on a treatment case though. It was successful but the time to get the payment was over a year, and my treatment billing person did not want to go through the hassles of trying to get P&I on a treatment case, since she did not think that the treatment IBR Regs had clear indications that it would be paid.

On a QME med-legal, I have found that the best way to get results is having staff work through direct email to the adjuster, and if that does not work, then find out their supervisor. It is not always easy to get the email address, but many times it can be figured out through the standardized email naming conventions of the company.

First, ALWAYS send your QME reports by a trackable means such as USPS Priority mail. Having that proof of delivery to their office is way more convincing that any Form 122 Proof of Service. Use both.

Call the IC company main switchboard and see if the adjuster you have is still working there. Many times they have moved on. Find out the name of the current adjuster, and and get the contact info for their supervisor. Sometimes a switchboard will give you the email address, though usually you have to work to figure it out.

When you are sure you have the right names, lay out your case, show proof of timely delivery and actions on your part, and quote the LC on missing payment and late payment P & I.

Also fax to the Adjuster, and their supervisor, and notify them that you have Fax Receipts showing delivery to their fax. Send them a PDF file of your fax receipt to show the documentation.

If no action, tell them that your intend to file an Audit Referral Form (From DWC-AU-906) within 10 days if no payment.

If their is an overall Claims Supervisor in the IC office, put them in the mix, let everyone know you are not going away until this is fixed.

If this does not work, find out the name of some Vice Presidents of the company and state your intent to contact them if your late payment is not resolved quickly. Nobody wants the brass coming to visit.

These steps have usually worked if we are consistent, repetitive, and use a ONLY a very professional voice in the emails, or any other written documents to the IC.
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Re: ibr delays decisions on late QME payment penalties (Californ

Postby jarmstrong on Mon Jan 18, 2016 8:36 am

I've had no difficulty collecting penalty payments on several cases.

But I had a case recently where there was an objection by one party to my assignment as QME. I didn't know this prior to the evaluation. I did the QME as arranged, and essentially in good faith.

2 years later after numerous bills (I did not pursue IBR, my bad,) I learned the reason I wasn't paid. I had filed a lien and had a bill collector on the case, but unbeknownst to be they abandoned the case without informing me, and I got a notice of lien hearing 10 days before the hearing. My lien was thrown out because there was no rep at the hearing and the activation fee wasn't filed.

Big lesson to me, pretty large fee... but cheap education.
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Re: ibr delays decisions on late QME payment penalties (Californ

Postby Manila on Mon Jan 18, 2016 1:05 pm

To my knowledge IBR does not do reviews for contested medical-legal bills. I believe they do bill reviews for treatment cases only. This may explain why you have no reply from Maximus. However, telling the IC you intend to file with IBR and actually do so [even though IBR will probably not reply] it may show the IC you are serious and they may in turn pay the outstanding debt and penalty and interest. This method costs you the IBR fee but may in the end be cost advantageous because otherwise you have a unsatisfied bill.

On another note, it is sad this type of "counterintelligence" must be used for doctors to be paid for legitimate bills. In so many ways the deck is stacked against doctors who simply wish to be paid for authorized services and motivated to help patients improve. Between UR, IBR and Bill Review, there are so many obstacles that many many good doctors understandably refuse to take workers' compensation patients.
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Re: ibr delays decisions on late QME payment penalties (Californ

Postby LawAdvocate on Wed Jan 27, 2016 2:40 pm

That is not true, IBR is also for disputed Med-Legal bills. If you go read the process for second bill appeals and IBR, you will note the form is ONLY mandatory for medical-legal providers, not for treaters.
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Re: ibr delays decisions on late QME payment penalties (Californ

Postby mk61347 on Mon Jun 06, 2016 2:12 am

I forgot to update my post. I finally received a response from IBR. They ruled that P&I are not part of the fee schedule and reviewable by IBR. To resolve the matter it must be taken to the local appeals board. My apology for not posting sooner. It did take over one year to get this decision
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Re: ibr delays decisions on late QME payment penalties (Californ

Postby louisianainsurancedefens on Mon Aug 22, 2016 1:04 am

Advances of disability retirement pursuant to Labor Code § 4850.4 [LC 4850.4] are not equivalent to regular workers’ compensation benefits, but rather are obligations of the employer and the employer’s retirement system that are administered through a separate statutory process and governed by an independent retirement board.
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