Md. Code Regs. 10.09.59.09

Current through Register Vol. 51, No. 22, November 1, 2024

Section 10.09.59.09 - Payment Procedures

A. Payment procedures shall be followed as specified in COMAR 10.09.36.04.

B. A provider shall deliver and document services in accordance with Department regulations in order to receive reimbursement.

C. Unless the care is free to other patients, a provider shall bill the Program its usual and customary charge to the general public.

D. The Department shall authorize supplemental payment on Medicare claims only if:

(1) The provider accepts Medicare assignments;

(2) Medicare makes direct payment to the provider;

(3) Medicare has determined that the services are medically necessary;

(4) The services are covered by the Program; and

(5) Initial billing is made directly to Medicare according to Medicare guidelines.

E. The Department shall make payment on Medicare claims subject to the following provisions:

(1) Deductible and coinsurance shall be paid in full for services designated as mental health services by Medicare; and

(2) The Program shall reimburse services not covered by Medicare, but considered medically necessary by the Program, according to the limitations of this chapter.

F. A provider may not bill the Program for:

(1) Completion of forms and reports;

(2) Broken or missed appointments;

(3) Professional services rendered by mail or telephone; or

(4) Services not authorized consistent with Regulation .08 of this chapter.

G. Billing time limitations for claims submitted under this chapter are set forth in COMAR 10.09.36.06.

H. The Department shall reimburse providers according to the fee schedule in COMAR 10.21.25.

I. Psychiatric rehabilitation programs shall identify the mental health professional who referred the individual to psychiatric rehabilitation services by recording the individual practitioner's National Provider Identifier (NPI) number on the claim.

Md. Code Regs. 10.09.59.09

Regulations .09 adopted as an emergency provision effective February 3, 1995 (22:4 Md. R. 232); adopted permanently effective June 5, 1995 (22:11 Md. R. 821)
Regulations .09 under, Rehabilitation and Other Mental Health Services, repealed and new Regulations .09 under, Specialty Mental Health Services, adopted effective December 22, 2014 (41:25 Md. R. 1479)
Regulation .09 amended effective 42:21 Md. R. 1300, eff.10/26/2015; amended effective 45:8 Md. R. 420, eff. 4/23/2018