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.