§Why CasetextPricing

Government Employees Insurance Co., et al., Respondents,v.Avanguard Medical Group, PLLC, Appellant.

Brief

11 Cited authorities

  1. Clark v. Cuomo

    66 N.Y.2d 185 (N.Y. 1985)   Cited 90 times
    Noting that the executive order required State agencies to make voter registration forms available through their staffs and provide assistance in completing the forms

  2. Government Employees Insurance v. Avanguard Medical Group

    127 A.D.3d 60 (N.Y. App. Div. 2015)   Cited 8 times

    2015-02-18 GOVERNMENT EMPLOYEES INSURANCE CO., et al., appellants, v. AVANGUARD MEDICAL GROUP, PLLC, respondent. Melito & Adolfsen, P.C., New York City ( Louis G. Adolfsen and S. Dwight Stephens of counsel), for appellants. Abrams, Fensterman, Fensterman, Eisman, Formato, Ferrara & Einiger, LLP, New York City ( John Belesi and David Verschell of counsel), for respondent. Greenberg Traurig, LLP, New York City ( Francis J. Serbaroli of counsel), for amicus curiae New York State Association of Ambulatory

  3. Section 5102 - Definitions

    N.Y. Ins. Law § 5102   Cited 10,106 times   1 Legal Analyses
    Providing the cause of action

  4. Section 1395x - Definitions

    42 U.S.C. § 1395x   Cited 1,160 times   40 Legal Analyses
    Stating that the regulations "may provide for using different methods in different circumstances"

  5. Section 1395ww - Payments to hospitals for inpatient hospital services

    42 U.S.C. § 1395ww   Cited 608 times   35 Legal Analyses
    Providing for a wage-index adjustment

  6. Section 5108 - Limit on charges by providers of health services

    N.Y. Ins. Law § 5108   Cited 97 times

    (a) The charges for services specified in paragraph one of subsection (a) of section five thousand one hundred two of this article and any further health service charges which are incurred as a result of the injury and which are in excess of basic economic loss, shall not exceed the charges permissible under the schedules prepared and established by the chairman of the workers' compensation board for industrial accidents, except where the insurer or arbitrator determines that unusual procedures or

  7. Section 2807-C - General hospital inpatient reimbursement for annual rate periods beginning on or after January first, nineteen hundred eighty-eight

    N.Y. Pub. Health Law § 2807-C   Cited 48 times
    Including in the Standard Rate tier those payments by "article forty-three corporations" "on behalf of subscribers of a foreign corporation as described in paragraph (d) of subdivision twelve of this section"

  8. Section 230-D - Office-based surgery

    N.Y. Pub. Health Law § 230-D   Cited 11 times

    1. The following words or phrases, as used in this section shall have the following meanings: (a) "Accredited status" means the full accreditation by nationally-recognized accrediting agency(ies) determined by the commissioner. (b) "Adverse event" means (i) patient death within thirty days; (ii) unplanned transfer to a hospital or emergency department visit within seventy-two hours of office-based surgery for reasons related to the office-based surgery encounter; (iii) unscheduled hospital admission

  9. Section 68.5 - Health services not set forth in schedules

    N.Y. Comp. Codes R. & Regs. tit. 11 § 68.5   Cited 27 times

    If a professional health service is performed which is reimbursable under section 5102(a)(1) of the Insurance Law, but is not set forth in fee schedules adopted or established by the superintendent, and: (a) if the superintendent has adopted or established a fee schedule applicable to the provider, then the provider shall establish a fee or unit value consistent with other fees or unit values for comparable procedures shown in such schedule, subject to review by the insurer; or (b) if the superintendent

  10. Section 86-4.40 - Computation of case-based rates of payment for licensed free-standing ambulatory surgery centers and hospital-based ambulatory surgery services

    N.Y. Comp. Codes R. & Regs. tit. 10 § 86-4.40   Cited 3 times

    (a) Medicaid reimbursement for ambulatory surgery services provided by licensed free-standing ambulatory surgical centers and hospital-based ambulatory surgery services shall be based upon a single payment schedule with a discrete price for each of the separate groupings of surgical procedures set forth in this section. (b) Reimbursement for ambulatory surgery services shall be based upon the Products of Ambulatory Surgery (PAS) classification system as defined in subdivision (o) of this section

  11. Section 755.2 - Administrative requirements

    N.Y. Comp. Codes R. & Regs. tit. 10 § 755.2

    When ambulatory surgery services are provided, the operator shall ensure that: (a) there is a documented plan and procedure for the transfer of patients to a nearby hospital when hospitalization is indicated. Such plans shall include arrangements for an ambulance service and, when appropriate, escort of the patient to the hospital by a clinical staff member of the ambulatory surgery service; (b) the specific ambulatory surgical procedures which each physician and dentist is qualified and competent