Bill > AB1048

This bill amends California's workers' compensation law to clarify and expand provisions related to independent bill review, which is a process for resolving disputes over medical treatment billing in workers' compensation cases. Specifically, the bill defines a payment dispute to include contract disputes involving discounts or reductions from the official medical fee schedule. The bill requires that if an independent bill review upholds a percentage discount or reduction, the review organization must provide a written decision to the medical provider that includes the specific medical provider contract(s) used to justify the decision. If the payer cannot produce a valid contract justifying the discount, the independent bill review organization must award payment consistent with the official medical fee schedule. The bill also maintains existing provisions that allow medical providers to request an independent bill review within 30 days if a payment dispute is not resolved, and it preserves the requirement that providers pay a fee to cover the administrative costs of the independent bill review process. This amendment aims to increase transparency and fairness in the workers' compensation medical billing review process by requiring more detailed explanations and documentation when billing disputes are adjudicated.

Budget and Finance, Business and Industry, Labor and Employment

https://leginfo.legislature.ca.gov/faces/billStatusClient.xhtml?bill_id=202520260AB1048