DIR Reduces Fees for IMR and IBR:

DIR Reduces Fees for Independent Medical Review, Independent Bill Review, by 25 Percent

 

The Department of Industrial Relations (DIR) has announced a reduction in Independent Medical Review and Independent Bill Review fees effective April 1, 2014. These new fees represent a 25 percent reduction. Parties who submitted an IMR or IBR on or after April 1, 2014 will receive a refund in the amount of fees paid in excess of the new fee schedule.  Reference Links on our website: "Contact/Helpful Links."

 

IMR Fees:

Any IMR application submitted on or after April 1, 2014 will be subject to the following fee schedule:

 

Standard IMRs Involving Non-Pharmacy Claims*

Previous Fee: $560 per IMR

Fee Effective April 1, 2014: $420 per IMR

 

Expedited IMRs Involving Non-Pharmacy Claims

Previous Fee: $685 per IMR

Fee Effective April 1, 2014: $515 per IMR

 

Standard IMRs Involving Pharmacy Only Claims**

Previous Fee: Not Applicable

Fee Effective April 1, 2014: $390 per IMRs

 

IMRs Terminated or Dismissed Not Forwarded to a Medical Professional Reviewer:

Previous Fee: $215 per IMR

Fee Effective April 1, 2014: $160 per IMR

 

IMRs Terminated or Dismissed After Case Forwarded to a Medical Professional Reviewer:

Previous Fee: $560 per IMR

Fee Effective April 1, 2014: $420 per IMR

 

IBR Fees:

 

Any IBR application submitted on or after April 1, 2014 will be subject to the following fee schedule.

 

Completed IBR

Previous Fee: $335 per IBR

Fee Effective April 1, 2014: $250 per IBR

 

Terminated IBR Not Sent to Review***

Previous Fee: $65 per IBR

Fee Effective April 1, 2014: $50 per IBR

 

* A “non-pharmacy-only” IMR is an IMR where not all treatments in dispute fall under the service category, “pharmaceuticals.”

** A “pharmacy-only” IMR is an IMR where all treatments in dispute fall under the service category “pharmaceuticals.”

*** Sending an IBR to review means assigning and providing the complete file to a certified coding specialist with the expertise necessary to evaluate and render decisions on all line items in dispute.

 

 

 

 

 

 

 

 

 

 

 

 

 

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