PORTLAND, March 1, 2003–Qmedtrix's methodology for reviewing Ambulatory Surgery Center Facility fees was again validated by the recent En banc decision in Kunz v. Patterson Floor Coverings, Inc. (Case No. SJO 224503).
Of note are the following points made by the board and documented in the case record:
- Outpatient facility fees must be reasonable.
- Important factors in a reasonable fee include the usual fee of other providers in the geographical area and costs of the service in that area.
- The facility's usual fee is not the amount charged, but the amount accepted for similar services in workers' compensation and non-workers' compensation claims.
- The billing must be properly documented.
View the
entire WCAB decision here:
Kunz v. Patterson Floor Coverings, Inc.
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