CompFox AI Summary
The Appeals Board granted the lien claimant's petition for reconsideration, finding the WCJ erred in ordering reimbursement based on federal regulations. The Board determined that long-term care hospitals are entitled to a reasonable cost basis for their services, not a predetermined federal rate. The case was returned to the trial level for the WCJ to determine a reasonable fee for the lien claimant. The Board also clarified that services from such facilities are exempt from the Official Medical Fee Schedule and the Administrative Director's Independent Bill Review process.
Full Decision Text1 Pages
The Appeals Board granted the lien claimant's petition for reconsideration, finding the WCJ erred in ordering reimbursement based on federal regulations. The Board determined that long-term care hospitals are entitled to a reasonable cost basis for their services, not a predetermined federal rate. The case was returned to the trial level for the WCJ to determine a reasonable fee for the lien claimant. The Board also clarified that services from such facilities are exempt from the Official Medical Fee Schedule and the Administrative Director's Independent Bill Review process.
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