Streamlining Second Bill Reviews in California Workers' Compensation

Medical billing disputes can complicate the Workers' Compensation process, making it essential for healthcare providers to understand how to navigate second bill reviews effectively. This blog post explores the steps and best practices for conducting a second bill review in California Workers' Compensation, ensuring accurate and timely resolution of billing disputes.

What is a Second Bill Review?

Definition:

A second bill review is a formal process where healthcare providers can dispute an initial payment decision made by an insurance carrier. This review allows for the correction of any errors or discrepancies, ensuring providers receive fair compensation for their services.

Steps in the Second Bill Review Process

Step 1: Submit the Second Bill Review Request

• Eligibility: If the provider disagrees with the payment or denial of a bill, they can request a second bill review within 90 days of receiving the Explanation of Review (EOR).
• Required Documentation: Include the original bill, the EOR, and any additional supporting documentation. The request should be submitted using the appropriate form as specified in §9792.5.6.

Step 2: Review by the Claims Administrator

• Initial Review: The claims administrator reviews the submitted documentation to verify compliance and accuracy.
• Decision Timeline: A decision must be issued within 14 days of receiving the second bill review request, either affirming, modifying, or reversing the initial payment decision.

Step 3: Resolution and Next Steps

• Resolution: If the dispute is resolved, the claims administrator processes the payment accordingly.
• Further Dispute: If the provider disagrees with the second review decision, they can request an Independent Bill Review (IBR) within 30 days of receiving the decision.

Best Practices for Second Bill Review Requests

Accurate Documentation: Ensure all forms and supporting documents are complete and accurate to avoid delays and improve the likelihood of a favorable outcome.

Timely Submissions: Submit all required documentation promptly to adhere to deadlines and facilitate timely processing.

Clear Communication: Maintain open communication with the claims administrator to address any issues or questions promptly.

Utilize Electronic Systems: Implement electronic billing systems to streamline submissions and reduce the risk of errors.

Stay Informed: Regularly review updates to the California Code of Regulations to ensure ongoing compliance with billing and review processes.

Benefits of a Thorough Second Bill Review

Fair Compensation: By ensuring that all billing details are accurate and complete, healthcare providers can secure fair compensation for their services.

Efficient Dispute Resolution: A streamlined review process minimizes delays and helps resolve disputes more efficiently, benefiting both providers and insurers.

Reduced Litigation Costs: Effective second bill reviews can prevent the need for costly and time-consuming legal disputes.



Interested in Partnering with Medrina Technology Management?

Medrina Technology Management specializes in providing comprehensive billing and compliance support services for workers' compensation treating providers. Our expertise ensures that medical providers meet all regulatory requirements and receive fair compensation. By handling all aspects of billing, payment, and dispute resolution, we allow healthcare providers to focus on delivering exceptional care. If you're interested in partnering with Medrina for efficient and reliable services, please contact us.