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.