Md. Code Regs. 10.11.03.13

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.11.03.13 - General Billing Procedures

A. A provider shall accept payment at the Medical Assistance rate as payment in full.

B. A provider shall submit:

(1) Requests for payment on the form designated by the CMS Program; and

(2) Completed reports and attachments as requested by the CMS Program.

C. A provider may not bill the CMS Program for:

(1) Completion of forms and reports;

(2) Broken or missed appointments;

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

(4) Services which are provided at no charge to the general public.

D. The CMS Program shall:

(1) Make no direct payment to the family;

(2) Pay any claim for services provided on different dates and submitted on a single form, and only if it is received by the CMS Program within 12 months of the earliest date of service; and

(3) Pay a claim which is rejected for payment due to improper completion or incomplete information, only if it is properly completed, resubmitted, and received by the CMS Program within the original 12-month period or within 60 calendar days of rejection, whichever is later.

E. The CMS Program reserves the right to return to the provider, before payment, all:

(1) Invoices not properly signed, completed, and accompanied by properly completed forms as required by the Department, to include any necessary preauthorization forms; and

(2) Claims not properly completed.

F. If payment is denied by the CMS Program due to late billing, the provider may not seek payment from the child's family.

Md. Code Regs. 10.11.03.13

Regulations .13 adopted effective November 28, 1988 (15:24 Md. R. 2769)
Regulations .13 amended and recodified from Regulation .20 effective 42:7 Md. R. 568, eff.4/13/2015