10.09.88.07

.07 Payment Procedures.

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

B. The Department shall allow a single transportation payment for each trip the portable X-ray provider makes to a particular location.

C. The Department shall reimburse for covered services at the lesser of:

(1) The providerís customary charge unless the service is free to individuals not covered by Medicaid; or

(2) The Departmentís fee schedule.

D. The Departmentís fee-schedule is contained in COMAR 10.09.02.07D.

E. Payments on Medicare cross-over claims are authorized if :

(1) The provider accepts Medicare assignment;

(2) Medicare makes direct payment to the provider;

(3) Medicare has determined that the services are medically necessary;

(4) The services are covered by the program; and

(5) The initial billing is made directly to Medicare according to Medicare guidelines.

F. The Department shall make supplemental payment on Medicare claims subject to the following provisions:

(1) Coinsurance shall be paid at the lesser of:

(a) 100 percent of the coinsurance amount; or

(b) The balance remaining after the Medicare payment is subtracted from the Medicaid rate.

G. The Program may not make a direct payment to a recipient.

H. Billing time limitations are those set forth in COMAR 10.09.36.06.

I. The provider may not bill the Program or recipient for:

(1) Completion of forms and reports;

(2) Broken or missed appointments;

(3) Services rendered by mail or telephone; and

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

J. The portable X-ray provider shall identify the individual who ordered the portable X-ray services by recording the individual practitionerís National Provider Identifier (NPI) number on the claim.