C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-55, subsec. 144-101-II-55.05
Physicians in private practice will be reimbursed only for those Laboratory Services provided in his/her office by the physician or the office staff, using the office equipment and supplies.
When only Laboratory Services are provided, an office visit charge may not be made.
For necessary Laboratory Services not done in the physician's office, the physician may make a written referral to:
The physician may not charge for making the referral.
The provider of the service is to charge the Department of Human Services directly and provide a written report of test results to the physician.
Prohibition on referrals. Except as provided in federal rule, a physician who has a financial relationship with an entity, or who has an immediate family member who has a financial relationship with the entity, may not make a referral to that entity for the furnishing of clinical Laboratory Services for which payment otherwise may be made under Medicaid.
The provider of the Laboratory Service shall participate in an on-going program of proficiency testing as described in 22 M.R.S.A. symbol 167 if "Kino MT" is 112025 and the rules and regulations promulgated thereunder and the rules implementing the CLIA 88. Failure to demonstrate satisfactory participation to the Department of Health and Human Services, Maine Center for Disease Control & Prevention, Health and Environmental Testing Laboratory shall result in the provider being ineligible for reimbursement by the Medicaid program for those Laboratory Services found not to be in compliance.
Purchase discounts have been classified as cash, trade, or quantity discounts. Cash discounts are reductions granted for the settlement of debts before they are due. Trade discounts are reductions from list prices granted to a class of customers before a consideration of credit terms. Quantity discounts are reductions from list prices granted because of the size of the individual or aggregate purchase transactions. Whatever the classification of purchase discounts, like treatment in reducing the billable costs is required.
All purchase discounts are reductions in cost and must be reflected in the amount billed the Department by the provider for Laboratory Services performed by a third party. The Department will pay only the lower of either the price established for said service in the Medicaid fee schedule, or the price actually paid by the provider to the third party for the service. The Department reserves the right to audit the provider's fiscal records in order to verify the proper application of any purchase discounts to the reduction of billable costs.
Out-of-state laboratories, while not subject to the Department's proficiency testing program, are required to be Medicare certified and licensed by the Health Care Financing Administration under the Clinical Laboratory Improvement Amendments of 1988.
C.M.R. 10, 144, ch. 101, ch. II, 144-101-II-55, subsec. 144-101-II-55.05