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Detailed guide on Maryland
Maryland's Surprise Medical Billing Law
- Balance Billing Protections: Maryland law prohibits balance billing for certain services, including emergency services, ground ambulance services, and services provided by out-of-network providers at in-network facilities.
- Emergency Services: If you receive emergency services from an out-of-network provider or facility, the most they can bill you is your plan's in-network cost-sharing amount.
- Good Faith Estimates: Uninsured and self-pay patients have the right to receive a good faith estimate of their potential bill for medical services.
- Balance Billing: Out-of-network providers may balance bill for the difference between what your plan agreed to pay and the full amount of the service. This is called "balance billing".
Maryland Medicaid Billing
- Medicaid Coverage: Maryland Medicaid covers a range of services, including doctor visits, hospital stays, and prescription medications.
- Medicaid Billing: Medicaid providers must follow specific billing guidelines and submit claims to the Maryland Medicaid program.
Maryland Workers' Compensation Billing
- Workers' Compensation Coverage: Maryland Workers' Compensation covers work-related injuries and illnesses.
- Workers' Compensation Billing: Workers' Compensation providers must follow specific billing guidelines and submit claims to the Maryland Workers' Compensation Commission.
Billing Disputes
- Dispute Resolution Process: If you have a billing dispute, you can contact the Maryland Insurance Administration or the Health Education and Advocacy Unit (HEAU) for assistance.
- Good Faith Estimates: If you believe you have been wrongly billed, you can request a good faith estimate from the provider or facility.
- Patient-Provider Dispute Resolution Process: Under the No Surprises Act, you can request a payment review and decision from an independent company certified by the federal Department of Health and Human Services.
Additional Guidelines
- Provider Directory Accuracy: Providers must maintain accurate directories of participating providers and facilities.
- Continuity of Care: Providers must ensure continuity of care for patients, including providing necessary medical information and treatment.
- Patient Rights: Patients have the right to receive accurate and timely information about their care, including the cost of services and any potential balance billing.
These guidelines and laws aim to ensure that healthcare providers and facilities follow specific procedures for billing and claims submission, protecting patients from surprise medical bills and ensuring timely and accurate payment for services.
Maryland's Medical Billing Guidelines
- ICD-10-CM Codes: Maryland requires the use of ICD-10-CM codes for diagnoses, including bills for PPD evaluations.
- CPT Codes: CPT codes are used for procedures, and they must be unbundled.
- HCPCS Codes: HCPCS codes are used for supplies, equipment, and drugs. Q3014 is an allowable service for FQHC/CCBHC and CCBHC.
Maryland Medicaid Billing
- Medicaid Coverage: Maryland Medicaid covers a range of services, including doctor visits, hospital stays, and prescription medications.
- Medicaid Billing: Medicaid providers must follow specific billing guidelines and submit claims to the Maryland Medicaid program.
Maryland Workers' Compensation Billing
- Workers' Compensation Coverage: Maryland Workers' Compensation covers work-related injuries and illnesses.
- Workers' Compensation Billing: Workers' Compensation providers must follow specific billing guidelines and submit claims to the Maryland Workers' Compensation Commission.
Billing Disputes
- Dispute Resolution Process: If you have a billing dispute, you can contact the Maryland Attorney General's Office or the Health Education and Advocacy Unit (HEAU) for assistance.
- Good Faith Estimates: If you believe you have been wrongly billed, you can request a good faith estimate from the provider or facility.
- Patient-Provider Dispute Resolution Process: Under the No Surprises Act, you can request a payment review and decision from an independent company certified by the federal Department of Health and Human Services.
Additional Guidelines
- Provider Directory Accuracy: Providers must maintain accurate directories of participating providers and facilities.
- Continuity of Care: Providers must ensure continuity of care for patients, including providing necessary medical information and treatment.
- Patient Rights: Patients have the right to receive accurate and timely information about their care, including the cost of services and any potential balance billing.
Examples of Codes Used in Maryland
- ICD-10-CM Code for Hypertension: I10.9 (Essential hypertension)
- ICD-10-CM Code for Diabetes: E11.9 (Type 2 diabetes mellitus without complications)
- ICD-10-CM Code for Heart Failure: I42.0 (Acute heart failure)
Examples of Codes Used in Medical Billing in Maryland
- CPT Code for ECG: 93000 (Electrocardiogram, routine ECG with 12 leads)
- CPT Code for Mammography: 77055 (Mammography, screening and diagnostic, 2 views)
- CPT Code for Colonoscopy: 45378 (Colonoscopy, flexible, with biopsy)
Examples of Codes Used in Medical Coding in Maryland
- ICD-10-CM Code for Pneumonia: J18.9 (Pneumonia, unspecified)
- ICD-10-CM Code for Chronic Obstructive Pulmonary Disease (COPD): J44.9 (Chronic obstructive pulmonary disease, unspecified)
- ICD-10-CM Code for Chronic Kidney Disease: N18.9 (Chronic kidney disease, unspecified)
These codes are used to accurately document and bill medical services in Maryland, ensuring timely and appropriate reimbursement for healthcare providers.