Code of Massachusetts Regulations
130 CMR - DIVISION OF MEDICAL ASSISTANCE
Title 130 CMR 450.000 - Administrative and Billing Regulations
Section 450.307 - Unacceptable Billing Practices
Universal Citation: 130 MA Code of Regs 130.450
Current through Register 1531, September 27, 2024
(A) No provider may claim payment in a way that may result in payment that exceeds the maximum allowable amount payable for such service under the applicable payment method.
(B) Without limiting the generality of 130 CMR 450.307(A), the following billing practices are forbidden:
(1) duplicate
billing, which includes the submission of multiple claims for the same service,
for the same member, by the same provider or multiple providers;
(2) overstating or misrepresenting services,
including submitting separate claims for services or procedures provided as
components of a more-comprehensive service for which a single rate of payment
is established; and
(3) submitting
claims under an individual practitioner's provider ID/service location number
for services for which the practitioner is otherwise entitled to
compensation.
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