Md. Code Regs. 10.09.51.07

Current through Register Vol. 51, No. 25, December 13, 2024

Section 10.09.51.07 - Payment Procedures

A. To obtain compensation from the Department for covered services, the provider shall submit a request for payment using the format designated by the Department.

B. Audiology services are reimbursed in accordance with COMAR 10.09.23.01-1.

C. The provider shall be paid the lesser of:

(1) The provider's customary charge to the general public, unless the service is free to individuals not covered by Medicaid; or

(2) The rate in accordance with the Department's fee schedule.

D. The provider may not bill the Department or participant for:

(1) Completion of forms and reports;

(2) Broken or missed appointments; or

(3) Professional services rendered by mail or telephone.

E. Audiology centers licensed as a part of a hospital may charge for and be reimbursed according to rates approved by the Health Services Cost Review Commission (HSCRC), set forth in COMAR 10.37.03.

F. The provider shall refund to the Department payment for hearing aids, supplies, or both, that have been returned to the manufacturer within the 30-day trial period.

G. The provider shall give the Department the full advantage of any and all manufacturer's warranties and trade-ins offered on hearing aids, equipment, or both.

H. Unless preauthorization has been granted by the Department or its designee, the Department is not responsible for any reimbursement to a provider for any service provided which requires preauthorization.

I. The Department may not make direct payment to participants.

J. Billing time limitations for claims submitted pursuant to this chapter are set forth in COMAR 10.09.36.

Md. Code Regs. 10.09.51.07

Regulation .07 amended effective January 16, 2006 (33:1 Md. R. 36); April 4, 2011 (38:7 Md. R. 431)
Regulation .07B amended effective April 21, 2008 (35:8 Md. R. 805); amended effective 43:13 Md. R. 713, eff. 7/4/2016; amended effective 44:4 Md. R. 253, eff. 2/27/2017; amended effective 45:21 Md. R. 973, eff. 10/8/2018; amended effective 45:21 Md. R. 973, eff. 10/22/2018