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55% of medical reviews are reversed: Report



More than half of the requested Independent Accounting reports in California's first five years of implementing the new process of reviewing injured treatments became the cover, according to a report published Tuesday by the California Department of Industrial Relations.

The report draws on data from the State Independent Audit Audit Bill, introduced with the State's 2013 implementation of the SB 863, which upgraded the state's comp system to include independent medical examinations aimed at resolving medical treatment and medical-legal service billing disputes to injured workers. The report includes 9,890 accounting review requests received between 2013 and 2017.

Of the audited bills, 55% were reversed and 22% maintained. The remaining 23 percent were either withdrawn or could not be reviewed according to the report.

The report also highlighted that 46% of challenged bills fell under the category of medical services, 1

7.9% fell in hospital wards and ambulatory surgical centers, and 12.6% of disputes came from remuneration rates. The other disputes fell between 0.1% and 6.6% and according to such categories as hospital care and pathology, according to the report.

Regarding the overriding procedural codes included in disputes, unlisted physical medicine / rehabilitation services received a maximum of 713 of the 9,890 review applications received that fall into that category. Other top credits include "comprehensive medical-legal evaluation with extraordinary circumstances" and "treatment of physician's progress report", respectively, by 378 and 362, respectively.

                    


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