<?xml version='1.0' encoding='utf-8'?>
<regulation prefix="Regulation" num=".07" citation="COMAR 10.09.88.07" title_num="10" subtitle_num="09" chapter_num="88" heading="Payment Procedures.">
  <paragraph num="A.">
    <text>General policies for payment that are applicable to all providers are set forth in COMAR 10.09.36.04.</text>
  </paragraph>
  <paragraph num="B.">
    <text>The Department shall allow a single transportation payment for each trip the portable X-ray provider makes to a particular location.</text>
  </paragraph>
  <paragraph num="C.">
    <text>The Department shall reimburse for covered services at the lesser of:</text>
    <paragraph num="(1)">
      <text>The provider’s customary charge unless the service is free to individuals not covered by Medicaid; or</text>
    </paragraph>
    <paragraph num="(2)">
      <text>The Department’s fee schedule.</text>
    </paragraph>
  </paragraph>
  <paragraph num="D.">
    <text>The Department’s fee-schedule is contained in COMAR 10.09.02.07D.</text>
  </paragraph>
  <paragraph num="E.">
    <text>Payments on Medicare cross-over 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>The services are covered by the program; and</text>
    </paragraph>
    <paragraph num="(5)">
      <text>The initial billing is made directly to Medicare according to Medicare guidelines.</text>
    </paragraph>
  </paragraph>
  <paragraph num="F.">
    <text>The Department shall make supplemental payment on Medicare claims subject to the following provisions:</text>
    <paragraph num="(1)">
      <text>Coinsurance shall be paid at the lesser of:</text>
      <paragraph num="(a)">
        <text>100 percent of the coinsurance amount; or</text>
      </paragraph>
      <paragraph num="(b)">
        <text>The balance remaining after the Medicare payment is subtracted from the Medicaid rate.</text>
      </paragraph>
    </paragraph>
  </paragraph>
  <paragraph num="G.">
    <text>The Program may not make a direct payment to a recipient.</text>
  </paragraph>
  <paragraph num="H.">
    <text>Billing time limitations are those set forth in COMAR 10.09.36.06.</text>
  </paragraph>
  <paragraph num="I.">
    <text>The provider may not bill the Program or recipient 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>Services rendered by mail or telephone; and</text>
    </paragraph>
    <paragraph num="(4)">
      <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="J.">
    <text>The portable X-ray provider shall identify the individual who ordered the portable X-ray services by recording the individual practitioner’s National Provider Identifier (NPI) number on the claim.</text>
  </paragraph>
</regulation>