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14.09.08.00.htm 14.09.08.00. Title 14 INDEPENDENT AGENCIES Subtitle 09 WORKERS' COMPENSATION COMMISSION Chapter 08 Guide of Medical and Surgical Fees Authority: Labor and Employment Article, §9-309, 9-663, and 9-731, Annotated Code of Maryland
14.09.08.01.htm 14.09.08.01. 01 Definitions.. A. In this chapter, the following terms have the meanings indicated.. B. Terms Defined.. 1) Ambulatory surgical center (ASC) means any center, service, office facility, or other entity that:a) Operates primarily for the purpose of providing surgical services to patients requiring a period of postoperative observation but not requiring overnight hospitalization; andb) Seeks reimbursement from payors as an ambulatory surgery center.. 2) "Authorized Provider" means:.
14.09.08.02.htm 14.09.08.02. 02 Incorporation by Reference.. The "Official Maryland Workers' Compensation Medical Fee Guide" (1995) is incorporated by reference..
14.09.08.03.htm 14.09.08.03. 03 Calculation of the Maximum Reimbursement Allowable.. A. For medical services and treatment provided before August 31, 2001, the MRA shall be the fees set forth in the Official Maryland Workers' Compensation Medical Fee Guide (1995) For anesthesiology services, the MRA is calculated by adding the Time Units and Base Units/Basic Value and multiplying that sum by a conversion factor: MRA = (Time Units + Base Units) × Conversion Factor.B. For medical services a
14.09.08.04.htm 14.09.08.04. 04 MRA or Fee Not Established.. A. The Commission has not established a medical fee schedule for dental services, durable medical equipment, and pharmaceuticals.B. For products and services for which the Commission has not established an MRA or medical fee schedule, including dental services, durable medical equipment, and pharmaceuticals, the insurance carrier shall assign a relative value to the product or service.C. An insurance carrier may base the assigned valu
14.09.08.05.htm 14.09.08.05. 05 Guidelines for Using Values and Codes.. A. The Maryland Workers' Compensation Act, implementing regulations, policies, and guidelines shall take precedence over any conflicting provision adopted or utilized by CMS in administering the CMS program.B. For coding, billing, reporting, and reimbursement of medical treatment and services, authorized providers shall apply the CPT/HCPCS code and CPT modifier in effect on the date the treatment or service was provided.
14.09.08.06.htm 14.09.08.06. 06 Reimbursement Procedures.. A. To obtain reimbursement under this chapter, an authorized provider shall:. 1) Complete Form CMS-1500 in accordance with the written instructions posted on the Commission's website; and2) Submit to the employer or insurer the completed Form CMS-1500, which shall include:. a) An itemized list of each service;. b) The diagnosis relative to each service;. c) The medical records related to the service being billed;.
14.09.08.07.htm 14.09.08.07. 07 Medical Records.. A. Medical records are the basis for determining whether a particular treatment or service is medically necessary and, therefore, reimbursable.B. Each health care provider is responsible for creating and maintaining legible medical records documenting the employee's course of treatment.C. Employee medical records shall include the:. 1) History of the patient;. 2) Results of a physical examination performed in conformity with the standard of practice of simila
14.09.08.08.htm 14.09.08.08. 08 Deposition Witness Fee.. A. After March 24, 2008, the Commission no longer regulates the reimbursement of deposition fees through a medical fee schedule.B. For witness depositions for which a bill has been submitted by the authorized provider before March 24, 2008, the authorized provider shall be allowed a witness fee if the provider submits a bill for the fee using the CPT code for the service.C. Reimbursement for a deposition is limited to the amount published in the
14.09.08.9999.htm 14.09.08.9999. Administrative History Effective date:. Regulation .01 adopted as an emergency provision effective August 1, 1987 (14:17 Md. R. 1869) emergency status expired July 31, 1988Regulation .01 adopted effective August 1, 1988 (15:14 Md. R. 1655). Regulation .01 amended effective August 1, 1991 (18:13 Md. R. 1484) ―. Regulation .01 repealed and new Regulation .01 adopted effective July 1, 1996 (23:12 Md. R. 872). Regulation .01 amended effective September 1, 2004 (31:13 Md. R. 995).
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