10.09.82.06

.06 Payment Procedures.

A. General policies for payment procedures that are applicable to all providers are set forth in COMAR 10.09.36.04.

B. Specific Payment Procedures for a Provider-Based Outpatient Oncology Facility.

(1) The provider shall submit a request for payment on the form designated by the Department for dates of service on or after July 1, 2012.

(2) Except for drugs which shall be billed to the Program using the National Drug Code (NDC) and appropriate the HCPCS, the Department shall reimburse the facility at an amount that is equal to 80 percent of the Medicare rate of reimbursement.

(3) The Department shall authorize payment on Medicare claims if:

(a) The provider accepts Medicare;

(b) Medicare makes direct payment to the provider; and

(c) Medicare has determined the services are medically necessary.

(4) The provider may not bill the Program or the recipient for:

(a) Completion of forms or reports;

(b) Broken or missed appointments; or

(c) Providing a copy of a recipientís medical record when requested by another licensed provider on behalf of the recipient.

(5) The Program makes no direct payments to recipients.

(6) The billing time limitations are set forth in COMAR 10.09.36.