Md. Code Regs. 10.11.03.19

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

Section 10.11.03.19 - Billing Procedures for Hospitals

A. All hospitals shall comply with the following procedures:

(1) Hospitals located in Maryland that participate in the CMS Program shall charge and be reimbursed at the Medical Assistance rates approved by the Health Services Cost Review Commission;

(2) The CMS Program shall pay room and board charges for the day of admission, and may not pay room and board charges for the day of discharge from the hospital;

(3) The CMS Program may not reimburse for the services of a hospital's salaried or contractual physicians as a separate line item;

(4). The contractual physicians' salaries shall be included in the room and board rate or the appropriate ancillary service;

(5) When a patient is discharged from one general hospital and is admitted to another general hospital and 24 hours have not elapsed between the discharge and admission, the CMS Program shall pay only for those medically necessary days, with the payment for the patient's hospitalization being apportioned between the two hospitals;

(6) The CMS Program shall be contacted regarding exceptions or extenuating circumstances relating to admissions and discharges if the patient returns the same day before the hospital patient count;

(7) All nonemergency inpatient hospital admissions require preadmission approval by the CMS Program;

(8) Authorization is required by the CMS Program or its designee for more than one preoperative inpatient day; and

(9) The CMS Program may not reimburse for hospital admissions where a child has been discharged due to cancellation of planned surgery or treatment. The hospital may not bill the family for these charges.

B. In addition, all out-of-state providers shall:

(1) Participate in Title XVIII of the Social Security Act;

(2) Have in effect a utilization review plan applicable to all patients who receive Medical Assistance under Title XIX of the Social Security Act and which meets the requirements of the Social Security Act, § 186(k), unless a waiver has been granted by the Secretary of Health and Human Services; and

(3) Meet additional conditions for participation and comply with the requirements specified in Regulation .11 of this chapter.

C. All hospital services shall be reimbursed at the Medical Assistance rate.

Md. Code Regs. 10.11.03.19

Regulations .19 and recodified from Regulation .26 amended effective 42:7 Md. R. 568, eff.4/13/2015