<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".06" citation="COMAR 10.09.82.06" title_num="10" subtitle_num="09" chapter_num="82" heading="Payment Procedures.">
  <paragraph num="A.">
    <text>General policies for payment procedures that are applicable to all providers are set forth in COMAR 10.09.36.04.</text>
  </paragraph>
  <paragraph num="B.">
    <text>Specific Payment Procedures for a Provider-Based Outpatient Oncology Facility.</text>
    <paragraph num="(1)">
      <text>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.</text>
    </paragraph>
    <paragraph num="(2)">
      <text>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.</text>
    </paragraph>
    <paragraph num="(3)">
      <text>The Department shall authorize payment on Medicare claims if:</text>
      <paragraph num="(a)">
        <text>The provider accepts Medicare;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Medicare makes direct payment to the provider; and</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Medicare has determined the services are medically necessary.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(4)">
      <text>The provider may not bill the Program or the recipient for:</text>
      <paragraph num="(a)">
        <text>Completion of forms or reports;</text>
      </paragraph>
      <paragraph num="(b)">
        <text>Broken or missed appointments; or</text>
      </paragraph>
      <paragraph num="(c)">
        <text>Providing a copy of a recipient’s medical record when requested by another licensed provider on behalf of the recipient.</text>
      </paragraph>
    </paragraph>
    <paragraph num="(5)">
      <text>The Program makes no direct payments to recipients.</text>
    </paragraph>
    <paragraph num="(6)">
      <text>The billing time limitations are set forth in COMAR 10.09.36.</text>
    </paragraph>
  </paragraph>
</regulation>