CompFox AI Summary
The Workers' Compensation Appeals Board (Appeals Board) reconsidered a prior decision that denied separate reimbursement for implanted hardware for lien claimant Pacific Hospital of Long Beach. The Appeals Board found that the WCJ misinterpreted regulations regarding hospital billing and reimbursement. Specifically, the Appeals Board determined that implanted hardware is separately reimbursable under section 9789.22(g) regardless of whether the inpatient services qualify as a cost outlier. Therefore, the Board rescinded the WCJ's decision and returned the case for further proceedings to calculate the correct payment for the implanted hardware.
Full Decision Text1 Pages
The Workers' Compensation Appeals Board (Appeals Board) reconsidered a prior decision that denied separate reimbursement for implanted hardware for lien claimant Pacific Hospital of Long Beach. The Appeals Board found that the WCJ misinterpreted regulations regarding hospital billing and reimbursement. Specifically, the Appeals Board determined that implanted hardware is separately reimbursable under section 9789.22(g) regardless of whether the inpatient services qualify as a cost outlier. Therefore, the Board rescinded the WCJ's decision and returned the case for further proceedings to calculate the correct payment for the implanted hardware.
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