453-05-8834-m4
DECISION AND ORDER Virginia Surety Company (Carrier) requested a hearing to contest the decision of the Texas Workers’ Compensation Commission’s (Commission) Medical Review Division (MRD)[1] ordering $3,182 in additional reimbursement for ambulatory surgical center (ASC) facility services that San Antonio Orthopaedic Surgical Center (Provider) provided to Claimant___. on February 19, 2004. The Administrative Law Judge […]
453-05-5844-m4
DECISION AND ORDER Vista Medical Center Hospital (Provider) requested a hearing on a decision by the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (Division)[1] denying additional reimbursement to Provider for a hospital stay provided to Claimant, an injured worker. Provider argued that reimbursement for this admission should be […]
453-05-5846-m4
DECISION AND ORDER Vista Medical Center Hospital (Provider) requested a hearing on a decision by the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (Division)[1] denying additional reimbursement to Provider for a hospital stay provided to Claimant, an injured worker. Provider argued that reimbursement for this admission should be […]
453-05-1472-m4
DECISION AND ORDER This unusual case concerns reimbursement for chronic pain management services provided the Claimant, ___, by the Respondent, Positive Pain Management (PPM). It is unusual because the only contested issue is whether the Petitioner, American Home Assurance Company (AHAC) properly filed a dispute with the Texas Workers’ Compensation Commission (the Commission) over whether […]
453-05-1490-m4-etal
DECISION AND ORDER Vista Healthcare, Inc. (Vista) contested decisions by the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission) denying additional payment for ambulatory surgical center (ASC) services.[1] Until November 2002, Vista operated an ASC in Houston, Texas. ASCs provide surgical support services to patients not requiring hospitalization. In these cases, Vista […]
453-05-5832-m4
DECISION AND ORDER Mainland Medical Center Hospital (Provider) requested a hearing on a decision by the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (Division)[1] denying additional reimbursement to Provider for a hospital stay provided to Claimant, an injured worker. Provider argued that reimbursement for this admission should be […]
453-05-7919-m4
DECISION AND ORDER East Houston Medical Center Hospital (Provider) requested a hearing on a decision by the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (Division),[1] denying additional reimbursement to Provider for a hospital stay provided to Claimant, an injured worker. Provider argued that reimbursement for this admission should […]
453-05-6802-m4
DECISION AND ORDER Vista Medical Center Hospital (Provider) requested a hearing on a decision by the Medical Review Division (MRD) of the Texas Department of Insurance, Division of Workers’ Compensation (Division)[1] denying additional reimbursement to Provider for a hospital stay provided to Claimant, an injured worker. Provider argued that reimbursement for this admission should be […]
453-03-0143-m4
DECISION AND ORDER I. INTRODUCTION Vista Healthcare, Inc. (Vista) requested a hearing to contest decisions by the Medical Review Division (MRD) of the Texas Workers’ Compensation Commission (Commission) denying additional payment for ambulatory surgical center services.[1] Vista operated ambulatory surgical centers (ASCs) in Houston, Texas, and provided surgical services to patients not requiring in-patient hospitalization. […]
453-99-1677-m4-etal
DECISION AND ORDER This decision addresses whether additional reimbursement is warranted for medical services provided between September 1, 1992, and February 13, 1997, that have already been reimbursed at levels set under the void 1992 Acute Care Hospital Fee Guideline (the 1992 Guideline) adopted by the Texas Workers’ Compensation Commission (the Commission). The Administrative Law […]