Code of Maryland Regulations › Title 10 - MARYLAND DEPARTMENT OF HEALTH › Part 2 › Subtitle 09 - MEDICAL CARE PROGRAMS › Chapter 10.09.92 - Acute Hospitals › Section 10.09.92.07 - Payment Procedures

Current through Register Vol. 51, No. 14, July 12, 2024
A.
				  Reimbursement Principles for Acute Hospitals Located in Maryland.
(1) The Department will make no direct
				  reimbursement to any State-operated hospital. The Department will claim federal
				  fund recoveries from the U.S. Department of Health and Human Services for
				  services to participants in State-operated hospitals.
(2) Except for administrative days, acute
				  hospitals shall be reimbursed at the rate set for the Program by the HSCRC
				  pursuant to COMAR 10.37.10 or allowed under COMAR 10.37.03.
(3) If the Program discontinues using rates
				  which have been approved by HSCRC, the Program shall reimburse providers:
(a) According to Medicare standards and
				  principles for retrospective cost reimbursement described in 42 CFR § 413
				  ; or
(b) On the basis of charges if
				  less than reasonable cost.
(4) The Department may not reimburse for the
				  services of a hospital's salaried or contractual clinical staff as a separate
				  line item. Charges for these services should be included in the room and board
				  rate or the appropriate ancillary service only, when HSCRC has included these
				  salaries in the hospital's costs.
(5) The Program shall reimburse room and
				  board charges from the day of admission up to, but not including, the date of
				  discharge from the hospital.
(6)
				  The provider shall submit a request for payment according to procedures
				  established by the Department.
(7)
				  The Program reserves the right to return to the provider any invoice that is
				  not properly completed.
(8)
				  Payments on Medicare claims are authorized if:
(a) The provider accepts Medicare
				  assignment;
(b) Medicare makes a
				  direct payment to the provider;
(c)
				  Medicare determined that services are medically necessary;
(d) The services are covered by the Program;
				  and
(e) Initial billing is made
				  directly to Medicare according to Medicare guidelines.
(9) The Department shall make a supplemental
				  payment on Medicare claims as follows:
(a)
				  Deductible and co-insurance shall be paid in accordance with the limits of this
				  regulation; and
(b) Hospitals shall
				  be paid subject to the HSCRC discounts, except in the case of a participant
				  receiving hospital services in an out-of-State facility, in which case the
				  deductible and co-insurance shall be paid in full.
(10) The provider shall not bill the
				  Department or participant for:
(a) Completion
				  of forms and reports;
(b) Broken or
				  missed appointments;
(c) Services
				  rendered by mail, telephone, or otherwise not in person, with the exception of
				  telehealth services in accordance with COMAR 10.09.49; and
(d) Providing a copy of a participant's
				  medical record, when requested by another licensed provider on behalf of the
				  participant.
(11) Billing
				  time limitations are set forth in COMAR 10.09.36.06.
(12) Freestanding medical facilities are
				  reimbursed by the Department at the rate set for the free standing facility by
				  HSCRC.