Md. Code Regs. 10.01.10.05

Current through Register Vol. 51, No. 20, October 4, 2024

Section 10.01.10.05 - Recovery and Reimbursement

A. If a client has insurance or if any other person is obligated, either legally or contractually, to pay for, or to reimburse the client for any service covered by this chapter, the medical provider shall seek payment from that source.

B. Payment. If payment is made by both the facility and insurance or other payer, the following conditions apply:

(1) If the facility has paid all or part of the invoice and the third-party payer has made payment that represents payment in full, then the medical provider shall return the facility's entire payment to the facility;

(2) If the facility has paid the invoice in full and if the third-party payer has made payment that represents partial payment, then the medical provider shall return the amount of the third-party payment to the facility;

(3) If a third-party payer has made payment that is intended to be a partial payment and the facility has paid the remainder, then no repayment to the facility is required.

C. The provider shall reimburse the facility for any overpayment.

Md. Code Regs. 10.01.10.05

Regulations .05 adopted as an emergency provision effective September 1, 1983 (10:20 Md. R. 1780); adopted permanently effective December 19, 1983 (10:25 Md. R. 2268)