<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".06" citation="COMAR 10.09.22.06" title_num="10" subtitle_num="09" chapter_num="22" heading="Payment Procedures.">
  <paragraph num="A.">
    <text>Reimbursement Principles.</text>
    <paragraph num="(1)">
      <text>Reimbursement by the Program is for services described in Regulation .04B of this chapter provided at a free-standing dialysis facility which has been approved for Medicare by the Division of Survey and Certification of CMS.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Reimbursement shall be consistent with the rates established by the Program for those services which are approved by Medicare.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Physician services are not reimbursed under this regulation. Reimbursement for physician services are in accordance with COMAR 10.09.02.07.</text>
    </paragraph>
  </paragraph>
  <paragraph num="B.">
    <text>The provider shall submit a request for payment on the form designated by the Department.</text>
  </paragraph>
  <paragraph num="C.">
    <text>The Program reserves the right to return to the provider, any invoice that is not properly completed.</text>
  </paragraph>
  <paragraph num="D.">
    <text>A provider shall bill the program the established Medicaid rate for dialysis services.</text>
  </paragraph>
  <paragraph num="E.">
    <text>Payments on Medicare claims are authorized if:</text>
    <paragraph num="(1)">
      <text>The provider accepts Medicare assignment;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Medicare makes direct payment to the provider;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Medicare has determined that the services are medically necessary;</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Services are covered by the program; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>Initial billing is made directly to Medicare according to Medicare guidelines.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>The Department will make supplemental payment on Medicare claims subject to the following provisions:</text>
    <paragraph num="(1)">
      <text>Deductible and coinsurance are to be paid in full; and</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Services not covered by Medicare are payable according to §D of this regulation.</text>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>The provider may not bill the Program for:</text>
    <paragraph num="(1)">
      <text>Completion of forms and reports;</text>
    </paragraph>
    <paragraph num="(2)">
      <text>Broken or missed appointments;</text>
    </paragraph>
    <paragraph num="(3)">
      <text>Professional services rendered by mail or telephone; or</text>
    </paragraph>
    <paragraph num="(4)">
      <text>Home visits unless satisfactorily documented as an emergency.</text>
    </paragraph>
  </paragraph>
  <paragraph num="H.">
    <text>The Program will make no direct payment to a participant.</text>
  </paragraph>
  <paragraph num="I.">
    <text>The Program will make no separate direct payment to any person employed by or under contract to any free-standing dialysis facility for services covered under this regulation.</text>
  </paragraph>
  <paragraph num="J.">
    <text>Billing time limitations for claims submitted pursuant to this chapter are set forth in COMAR 10.09.36.</text>
  </paragraph>
</regulation>