454-11-9324-m4
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by Zurich American Insurance Company (Zurich) for hospital outpatient procedures (HOP) performed at Vista’s facility for an injured worker. The services were provided on December 16, 2005. The services consisted of a rotator cuff repair, billed under CPT code 23412 and […]
454-12-0478-m4-etal
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by Zurich American Insurance Company (Zurich) for hospital outpatient procedures performed at Vista’s facility for the same injured worker on three occasions. The services were provided on April 12, 2007;[1] April 26, 2007;[2] and June 7, 2007.[3] The April 12, 2007 […]
454-11-9532-m4
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by ________ for hospital outpatient (HOP) services—an injection of anesthetic to spinal canal (IASC), CPT Code 64470—provided to an injured worker on December 20, 2004, and on May 2, 2005. The Administrative Law Judge (ALJ) finds that Vista failed to prove […]
454-11-9584-m4
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by ______ for hospital outpatient (HOP) services, specifically a manipulation under anesthesia of a shoulder joint (MASJ), CPT Code 23700, provided to an injured worker on December 14, 2006. The Administrative Law Judge (ALJ) finds that the evidence failed to prove […]
454-12-1987-m4-etal
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by ______ for hospital outpatient procedures (HOP) performed at Vista’s facility on four separate occasions for the same injured worker. The services were provided on October 3, 2006,[1] October 31, 2006,[2] December 5, 2006,[3] and March 20, 2007.[4] The October 3, […]
454-12-5238-m4
DECISION AND ORDER Seabright Insurance Company (Seabright) seeks to deny additional reimbursement to Sierra Medical Center (Sierra) for inpatient hospital surgical services provided to an injured worker (Claimant) from June 3, 2011, to June 5, 2011, at Sierra. The Administrative Law Judge (ALJ) finds Sierra is entitled to additional reimbursement in the amount of $7,014.81. […]
454-12-2542-m4
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by State Office of Risk Management (SORM) for hospital outpatient procedures (HOP) performed at Vista’s facility on four separate occasions for the same injured worker. The services were provided on September 18, 2007,1 October 9, 2007,2 October 23,3 and October 16, […]
454-12-2543-m4
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by State Office of Risk Management (SORM) for hospital outpatient procedures (HOP) performed at Vista’s facility on four separate occasions for the same injured worker. The services were provided on September 18, 2007,1 October 9, 2007,2 October 23,3 and October 16, […]
454-12-2544-m4
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by State Office of Risk Management (SORM) for hospital outpatient procedures (HOP) performed at Vista’s facility on four separate occasions for the same injured worker. The services were provided on September 18, 2007,1 October 9, 2007,2 October 23,3 and October 16, […]
454-12-2616-m4
DECISION AND ORDER Vista Medical Center Hospital (Vista) challenges the denial of additional reimbursement by State Office of Risk Management (SORM) for hospital outpatient procedures (HOP) performed at Vista’s facility on four separate occasions for the same injured worker. The services were provided on September 18, 2007,1 October 9, 2007,2 October 23,3 and October 16, […]