Searching over 5,500,000 cases.


searching
Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.

Physical Therapy Inst., Inc. v. Bureau of Workers' Comp. Fee Review Hearing office (Selective Ins. Co. of SC)

Commonwealth Court of Pennsylvania

January 16, 2015

Physical Therapy Institute, Inc., Petitioner
v.
Bureau of Workers' Compensation Fee Review Hearing Office (Selective Insurance Company of SC), Respondent

 Submitted October 10, 2014

For petitioner: Christopher E. Fisher, Lemoyne.

For respondent: Charles S. Katz, Jr., Paoli.

BEFORE: HONORABLE DAN PELLEGRINI, President Judge, HONORABLE MARY HANNAH LEAVITT, Judge, HONORABLE ANNE E. COVEY, Judge.

OPINION

MARY HANNAH LEAVITT, J.

Physical Therapy Institute, Inc. petitions for review of an adjudication of the

Page 958

Bureau of Workers' Compensation Fee Review Hearing Office (Bureau) dismissing the request of Selective Insurance Company of SC (Insurer) for a hearing to contest fee review determinations made by the Bureau's Medical Fee Review Section. Insurer asserted that it did not have liability for invoices issued by an entity that was not the provider of medical treatment to a claimant. The Bureau held that it lacked subject matter jurisdiction over Insurer's request for a hearing. Nevertheless, the Bureau vacated the fee review determinations challenged by Insurer on grounds that the Bureau's Medical Fee Review Section lacked authority to consider the applications. Physical Therapy Institute has appealed the Bureau's vacating of the fee review determinations. We affirm.

On August 16, 2012, Timothy Aston (Claimant) injured his low back while working for Greensburg Beverage, Inc., for which he was prescribed physical therapy. Insurer denied Physical Therapy Institute's invoices for this treatment for the stated reason that it did not actually provide physical therapy to Claimant, explaining as follows:

The billing entity, the Physical Therapy Institute, did not provide the injured worker with the physical therapy services for which payment is sought. The services were provided by a Medicare Part B provider. Its level of reimbursement is much lower than that of [Physical Therapy Institute], a Medicare Part A provider. The Part B provider has not submitted a bill for consideration. Under the PA [Workers' Compensation] Act,[1] the amount of payment owed to the Physical Therapy Institute is $0.00.

Reproduced Record at 230a, 269a, 301a, 332a, 366a (R.R. ).

Physical Therapy Institute filed five separate fee review applications, requesting review of the " amount of payment." R.R. 223a, 264a, 296a, 327a, 359a. Its first application related to treatment provided from September 4, 2012, to September 21, 2012, for which it billed $4,042.38. The second application related to treatment provided from September 24, 2012, to September 27, 2012, for which it billed $1,816.29. The third application related to treatment provided on October 15, 2012, for which it billed $537.12. The fourth application related to treatment provided from December 17, 2012, to January 3, 2013, for which it billed $3,417.31. The Bureau's Medical Fee Review Section ordered full payment on all these invoices plus ten percent interest. The fifth application related to treatment provided from January 7, 2013, to January 14, 2013, for which Physical Therapy Institute billed $2,330.12. The Bureau's Medical Fee Review Section reduced this invoice to $2,219.36 and ordered its payment plus ten percent interest.

Insurer then filed a " Request for Hearing to Contest Fee Review Determination," seeking a de novo hearing on all five determinations. R.R. 1a-8a. Insurer identified the issue as whether a Medicare Part B provider may contract with a Medicare Part A provider, i.e., Physical Therapy Institute, to use the Medicare Part A provider's tax identification number in order " to obtain reimbursement at the level of a Medicare Part A provider which is significantly in excess of the level of payment to a Medicare Part B provider." R.R. 2a, 4a, 6a, 8a.

The matter was assigned to the Bureau's Hearing Office. At a pre-trial conference, Insurer stated its intention to ...


Buy This Entire Record For $7.95

Download the entire decision to receive the complete text, official citation,
docket number, dissents and concurrences, and footnotes for this case.

Learn more about what you receive with purchase of this case.