Code of Maryland Regulations
Title 10 - MARYLAND DEPARTMENT OF HEALTH
Part 2
Subtitle 09 - MEDICAL CARE PROGRAMS
Chapter 10.09.10 - Nursing Facility Services
Section 10.09.10.23 - Third Party Liability Reviews and Audits of Nursing Facilities
Universal Citation: MD Code Reg 10.09.10.23
Current through Register Vol. 51, No. 19, September 20, 2024
A. Quarterly Reports of Credit Balances. A provider shall report the credit balances of the nursing facility to the Department on a quarterly basis.
B. Third Party Liability Review. The Department shall conduct a third party liability review of the reports of the credit balances provider under §A of this regulation.
C. Third Party Liability Audit of Random Sample. The Department or its designee may conduct a third party liability audit of a random sample of the reports of credit balances reviewed under §B of this regulation.
D. Third Party Liability Audit of Noncompliant Nursing Facility.
(1) Subject to §D(2) of this regulation,
the Department or its designee may conduct a third party liability audit of a
nursing facility that is found to be noncompliant under §B of this
regulation.
(2) In conducting the
third party liability audit, the Department or its designee may only review the
financial information of the nursing facility for the 2-year period immediately
before the first day of the audit period in which the nursing facility was
found to be noncompliant.
E. Appeal Rights of Nursing Facility.
(1) A provider may appeal the results of a
final report of a third party liability audit by filing written notice with the
Department within 30 days after the provider receives the final report from the
Department.
(2) An individual at
the Department who did not participate in the final report shall:
(a) Review the appeal and contact a provider
representative, if clarification is necessary; and
(b) Issue a report that either revises or
concurs with the final report of the third party audit.
(3) A provider may appeal the results of the
report issued by the Department under §E(2) of this regulation by filing
written notice with the Nursing Home Appeal Board within 30 days of receipt of
the report.
(4) If the provider
does not appeal the results of the third party liability audit by filing
written notice with the Department:
(a) The
amount due as set out in the final report shall be paid to the Department
within 60 days of the receipt by the provider of the results of the third party
liability audit; or
(b) On or after
the 61st day, after receipt by the provider of the results of the third party
liability audit, the Department may withhold the amount as set out in the final
report from future payments due the provider by the Department unless an agreed
on payment plan has been entered into by the Department and the
provider.
(5) If the
provider appeals the results of a final report of a third party liability audit
as authorized under §E(1) of this regulation, interest shall be charged on
the amount appealed and shall continue until date of payment. The interest rate
shall be based on the 6-month Treasury Bill rate in effect on the date the
appeal was filed.
(6) After a
decision adverse to the provider by the Nursing Home Appeal Board and written
notice to the provider of that decision by the Department:
(a) The amount determined to be due to the
Department as a result of the third party liability audit shall be paid to the
Department with accrued interest due; or
(b) On or after the 61st day, the Department
may withhold the amount due pursuant to the decision of the Nursing Home Appeal
Board from future payments due the provider by the Department unless an agreed
on payment plan has been entered into by the Department and the
provider.
Disclaimer: These regulations may not be the most recent version. Maryland may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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