All Saints Health Sys. v. Tex. Workers’ Comp. Comm’n

125 S.W.3d 96 (Tex. App.--Austin 2003, pet. denied)

On behalf of Continental Casualty Company, we helped obtain a declaratory judgment regarding the substantive law to be applied to claims for additional reimbursement based on services which the hospitals rendered to workers’ compensation claimants under the 1992 Hospital Fee Guideline, which the Austin Court of Appeals invalidated in 1995. The hospitals argued that their claims for additional reimbursement should be paid under an expired temporary rule, which provided for reimbursement at between 85% and 100% of their billed charges. The Austin Court held that the invalidation of the 1992 Hospital Fee Guideline did not resurrect the old rule and that reimbursement should be determined pursuant to the standards for “fair and reasonable” reimbursement which apply in the absence of a fee guideline. This decision applied to the remaining cases which were not disposed of by the Court’s opinion in Hospitals v. Continental Casualty Company. In individual cases in which the fair and reasonable standard was applied, it was subsequently determined that the hospitals were not entitled to additional reimbursement.